title: A unique presentation of four thrombotic events at a time.
abstract: A 72-year-old man was referred to our hospital as a case of postcardiac arrest following a long distance air flight. Work-up in the emergency department revealed the presence of deep vein thrombosis (DVT), bilateral pulmonary embolism, inferior STEMI (ST elevation myocardial infarction) and ischaemic stroke. He received thrombolysis by recombinant tissue plasminogen activator (tPA) following which his haemodynamic status improved, but he developed haemorrhagic transformation of the stroke as a complication. The haemorrhagic lesion gradually resolved with conservative management, leaving behind a residual neurological deficit. His haemodynamic status was stable after the management. Although a diagnosis of right-to-left shunt lesion was highly suggestive in this condition, it could not be confirmed on the transthoracic echocardiogram. Our patient had a unique presentation of multiple thrombi in different organs that caused significant morbidity and haemodynamic instability. There are no well-established guidelines that discuss the acute management of such cases. This situation requires a careful assessment and management of the patient by a multidisciplinary team.
authors.affiliation: Department of Cardiology, Rashid Hospital, Dubai Health Authority, United Arab Emirates. arrajani@dha.gov.ae
authors.forename: Ali Raza
authors.initials: AR
authors.lastname: Rajani
authors.forename: Kosar
authors.initials: K
authors.lastname: Hussain
authors.forename: Fahad Omar
authors.initials: FO
authors.lastname: Baslaib
authors.forename: Ghazi Ahmad
authors.initials: GA
authors.lastname: Radaideh
mesh_terms: D000368:Aged; D000401:Aircraft; D000792:Angiography; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000188:drug therapy; D004562:Electrocardiography; D019983:Guideline Adherence; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000188:drug therapy; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014195:Travel; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D010959:Tissue Plasminogen Activator