Pulmonary Embolism with Floating Right Atrial Thrombus Successfully Treated with Streptokinase

Authors

  • Sahela Nasrin Associate Consultant & Assistant Professor, Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka
  • Mohammad Salahuddin Registrar and Specialist, Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka
  • Fathima Aaysha Cader Assistant Registrar, Department of Cardiology,, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka
  • Md Jabed Iqbal Registrar and Specialist, Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka
  • Tahera Nazrin Associate Consultant & Assistant Professor, Department of Paediatric Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka
  • Masuma Jannat Shafi Registrar and Specialist, Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka
  • Nusrat Ghafoor Associate Consultant, Department of Radiology & Imaging, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka

DOI:

https://doi.org/10.3329/akmmcj.v7i1.31616

Keywords:

massive pulmonary embolism, right atrial thrombus, streptokinase

Abstract

Massive Pulmonary Embolism (PE) is associated with significant mortality, especially if compounded by haemodynamic instability, right ventricular dysfunction and right atrial thrombus. Thrombolysis can be lifesaving in patients with major embolism and cardiogenic shock, and accelerates the resolution of thrombus. Only three fibrinolytic agents - namely streptokinase, urokinase, and recombinant tissue plasminogen activator (Alteplase) have been approved in the treatment of PE, with studies demonstrating similar safety profiles. We report the case of a 33 year old Bangladeshi female with a history of recent ankle fracture and immobilization, who presented with massive PE, leading to cardiac arrest. Upon rapid resuscitation, urgent echocardiogram revealed right ventricular dysfunction with floating right atrial thrombus, and she was successfully treated with 1.5 million IU of Streptokinase over 2 hours as per accelerated regimen recommended by the European Society of Cardiology (ESC) guidelines, resulting in successful resolution of the right heart thrombus, and significant clinical improvement. Subsequent CT Pulmonary Angiogram confirmed the diagnosis of PE, and she was anticoagulated to a PT/INR of 2.0 to 3.0.

Anwer Khan Modern Medical College Journal Vol. 7, No. 1: Jan 2016, P 60-63

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Author Biography

Sahela Nasrin, Associate Consultant & Assistant Professor, Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka



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Published

2017-02-16

How to Cite

Nasrin, S., Salahuddin, M., Cader, F. A., Iqbal, M. J., Nazrin, T., Shafi, M. J., & Ghafoor, N. (2017). Pulmonary Embolism with Floating Right Atrial Thrombus Successfully Treated with Streptokinase. Anwer Khan Modern Medical College Journal, 7(1), 60–63. https://doi.org/10.3329/akmmcj.v7i1.31616

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Section

Case Reports