title: Disseminated intravascular coagulation with congestive heart failure and left ventricular thrombus: a case report with literature review of 7 cases.
abstract: BACKGROUND
  Coagulation abnormalities can accompany acute congestive heart failure (CHF). However, disseminated intravascular coagulation (DIC) is rarely documented in such patients. DIC is characterized by generalized excessive activation of coagulation pathways followed by their depletion with secondary activation of anticoagulation and fibrinolysis. Treatment of the cause is an integral part of management of DIC; thus, recognition of the cause is critical.
  
  
  METHODS
  A 55-year-old previously healthy man presented with breathlessness, swelling of both legs, and left leg pain. His physical exam result was consistent with decompensated heart failure. Further testing revealed multiple deep venous thrombi in the upper and lower extremities, arterial occlusion in the left popliteal artery, and an unusual cyst-like left ventricular thrombus. His laboratory evaluation was consistent with severe acute DIC. The patient was managed aggressively with diuretics, transfusions of platelets, and cryoprecipitate and was subsequently anticoagulated. His platelet count and coagulation parameters normalized and coronary angiography did not reveal any obstructive lesions. On day 22, an echocardiogram revealed and MRI confirmed that the intracardiac thrombus had disappeared. He underwent revascularization of the left leg and was successfully discharged from the hospital.
  
  
  CONCLUSIONS
  Severe biventricular non-ischemic cardiac dysfunction with intra-cardiac thrombi should be considered in patients presenting with DIC. In addition to anticoagulation, treatment of underlying heart failure is critical in such cases.
authors: Division of Cardiology, Department of Medicine, Albany Medical Center, Albany, NY, USA.
authors: Dmitri
authors: D
authors: Belov
authors: Division of Cardiology, Department of Medicine, Albany Medical Center, Albany, NY, USA.
authors: Radmila
authors: R
authors: Lyubarova
authors: Division of Cardiology, Department of Medicine, Albany Medical Center, Albany, NY, USA.
authors: Steven
authors: S
authors: Fein
authors: Division of Cardiology, Department of Medicine, Albany Medical Center, Albany, NY, USA.
authors: Mikhail
authors: M
authors: Torosoff
mesh_terms: D001777:Blood Coagulation; D003937:Diagnosis, Differential; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D004452:Echocardiography; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis; D006352:Heart Ventricles; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000150:complications* / Q000175:diagnosis
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