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Heart failure as an initial manifestation of antiphospholipid syndrome. KY. Juarez Escobar 1 , J E. Cruz 1 , J. Vargas Penafiel 1 , M. Jimenez Cruz 1 , J. Gomez Leon 1 , A. Lara Olivares 1 , R. Baleon Espinoza 1 IMSS Hospital de Especialidades la Raza Cardiologia, mexico, city, Mexico Primary Antiphospholipid Syndrome is characterized as an inflammatory disease; it produces recurrent arterial and venous thrombosis, fetal losses, and thrombocytopenia in association with the presence of serum antibodies to phospholipids. We report the case of a 30-year-old male, who was admitted to the emergency room complaining of exertion dyspnea, asthenia and adynamia for the last 3 months, with no history of thrombosis, with initial manifestation of heart failure. We found evidence of thrombocytopenia and abnormal coagulation times;echocardiography showed left ventricle: DD 48mm, SD 35mm, LVEF 60%, normal cardiac contractility, right ventricle: dilated with moderate free wall hypokinesia, moderate tricuspid regurgitation, moderate pulmonary hypertension, and a snake-like hyperkinetic mass attached to the right atrial roof near to the superior vena cava outlet, sized 50x6 mm, and almost in contact with the tricuspid valve. Immunological test results were positive for lupus anticoagulant, IgG anticardiolipin, and ANCA. An anticoagulation management was selected, based on unfractionated heparin, along with control echocardiography after 2 weeks of treatment, without clot evidence within cardiac cavities after clinical resolution of the heart failure. The subsequent treatment decision was hospital discharge with rigorous anticoagulation treatment. In summary, patients may present valvular vegetations, thickening, or heart failure. Heart failure could develop during the evolution of the disease and it is the cardinal manifestation in this case, despite the low incidence of its investigation. Nevertheless, no cases have been documented to show the presence of an atrial attached thrombus as a unique manifestation of Bibliography Espínola-zavaleta, Vargas-barrón j , et al. Echocardiographic evaluation of patients with primary antiphospholipid syndrome. Am Heart j 1999;137:974-9 Roldan o. Valvular and coronary heart disease in systemic inflammatory diseases. Heart 2008;94:1089–1101 Escudero t , Tettamanti a. et al. Atrial mass and antiphospholipid syndrome. Echocardiography: a jrnl. of cv ultrasound & allied tech. vol. 20, no. 2, 2003 Amigo mc, Khamashta ma: A ntiphospholipid syndrome in systemic lupus erythematosus. Rheum dis clin north am 2000;26:331–348

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Heart failure as an initial manifestation of antiphospholipid syndrome . KY. Juarez Escobar 1 , J E. Cruz 1 , J. Vargas Penafiel 1 , M. Jimenez Cruz 1 , J. Gomez Leon 1 , A. Lara Olivares 1 , R . Baleon Espinoza 1 - PowerPoint PPT Presentation

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Page 1: Heart failure  as  an initial manifestation  of  antiphospholipid syndrome

Heart failure as an initial manifestation of antiphospholipid syndrome.

KY. Juarez Escobar1, J E. Cruz1, J. Vargas Penafiel1, M. Jimenez Cruz1, J. Gomez Leon1, A. Lara Olivares1, R. Baleon Espinoza1

IMSS Hospital de Especialidades la Raza Cardiologia, mexico, city, MexicoPrimary Antiphospholipid Syndrome is characterized as an inflammatory disease; it produces recurrent arterial and venous thrombosis, fetal losses, and thrombocytopenia in association with the presence of serum antibodies to phospholipids. We report the case of a 30-year-old male, who was admitted to the emergency room complaining of exertion dyspnea, asthenia and adynamia for the last 3 months, with no history of thrombosis, with initial manifestation of heart failure. We found evidence of thrombocytopenia and abnormal coagulation times;echocardiography showed left ventricle: DD 48mm, SD 35mm, LVEF 60%, normal cardiac contractility, right ventricle: dilated with moderate free wall hypokinesia, moderate tricuspid regurgitation, moderate pulmonary hypertension, and a snake-like hyperkinetic mass attached to the right atrial roof near to the superior vena cava outlet, sized 50x6 mm, and almost in contact with the tricuspid valve. Immunological test results were positive for lupus anticoagulant, IgG anticardiolipin, and ANCA. An anticoagulation management was selected, based on unfractionated heparin, along with control echocardiography after 2 weeks of treatment, without clot evidence within cardiac cavities after clinical resolution of the heart failure. The subsequent treatment decision was hospital discharge with rigorous anticoagulation treatment.In summary, patients may present valvular vegetations, thickening, or heart failure. Heart failure could develop during the evolution of the disease and it is the cardinal manifestation in this case, despite the low incidence of its investigation. Nevertheless, no cases have been documented to show the presence of an atrial attached thrombus as a unique manifestation of an intracardiac effect..

BibliographyEspínola-zavaleta, Vargas-barrón j , et al. Echocardiographic evaluation of patients with primary antiphospholipid syndrome. Am Heart j 1999;137:974-9 Roldan o. Valvular and coronary heart disease in systemic inflammatory diseases. Heart 2008;94:1089–1101 Escudero t , Tettamanti a. et al. Atrial mass and antiphospholipid syndrome. Echocardiography: a jrnl. of cv ultrasound & allied tech. vol. 20, no. 2, 2003Amigo mc, Khamashta ma: Antiphospholipid syndrome in systemic lupus erythematosus. Rheum dis clin north am 2000;26:331–348