title: A floating right heart thrombus in transit across tricuspid valve causing an endocardial friction rub.
abstract: We report a 42-year-old lady on combined oral contraceptive pills with deep venous thrombosis and mild pulmonary embolism, who developed shock, while being treated with heparin. On auscultation, there was an unexpected loud, superficial, squeaky, triphasic friction rub over the left lower parasternal area. Simultaneous echocardiogram revealed a large serpiginous, freely floating mass in right atrium, prolapsing freely to right ventricular inlet across the tricuspid valve. The endocardial friction rub persisted for about 24 h as long as the thrombus was intracardiac and disappeared when the thrombus disappeared from right heart, occluding the proximal left pulmonary artery. She died due to shock awaiting surgery. We highlight that such a rub in a patient with deep venous thrombosis, though rare, may be an important clue to impending pulmonary embolism.
authors.affiliation: Department of Cardiology, Government Medical College, Kozhikode, India. Electronic address: drbabuk@yahoo.co.in.
authors.forename: Babu
authors.initials: B
authors.lastname: Kanjirakadavath
authors.forename: M N
authors.initials: MN
authors.lastname: Krishnan
authors.forename: D
authors.initials: D
authors.lastname: Vinayakumar
authors.forename: Deepak
authors.initials: D
authors.lastname: Raju
authors.forename: P G
authors.initials: PG
authors.lastname: Nithin
authors.forename: K F
authors.initials: KF
authors.lastname: Rajesh
authors.forename: Pradeep
authors.initials: P
authors.lastname: Sreekumar
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D003328:Coronary Thrombosis / Q000209:etiology*; D004452:Echocardiography; D017809:Fatal Outcome; D005260:Female; D006347:Heart Sounds; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000209:etiology*; D014261:Tricuspid Valve; D020246:Venous Thrombosis / Q000150:complications* / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: Endocardial friction rub; Pulmonary artery; Thromboembolism; Thrombus in transit