New Horizons in Translational Medicine,2017,1,1,11.
Introduction: Thrombi of the left atrium are common sources of stroke, and since left atrium and LAA thrombi are treatable causes of embolism, the detection of thrombi may affect patient treatment and outcome substantially. Bedside ultrasound in emergency department is a standard of care and can diagnosed intracardiac thrombus and lead to potentially lifesaving treatment. Case description: Here we are going to report a case of a patient who is 35-year-old Nepalese male with no known past medical history. He presented with right sided weakness and numbness for one day asso- ciated with minimal shortness of breath, palpitations and chest pain associated with visual disturbance in the right eye. On examination in the ED his GCS 15/15 with right sided weakness both upper and lower limb power 4/5 with sensory impairment. His chest was clear and heart sounds were irregular with loud S1. Rest of exam was unremarkable. Results and conclusions: An ECG showed atrial fibrillation with fast ventricular response. Bedside transthoracic echo done in ED showed evidence of mitral stenosis with left atrial enlargement and left atrial thrombus. CT head showed large subacute left occipital infarction extending to left thalamus patient was evaluated by both neurologist and cardiologist and started on IV heparin followed by warfarin to keep INR 2- 3. Official echo showed rheumatic appearing mitral valve with moderate to severe mitral stenosis and left atrial fresh thrombus occupying roof and lateral wall of left atrium. Take-home message: This case demonstrates the utility of ED physi- cian performing echocardiography to diagnose a dilated left atrium with a thrombus as the source of emboli in a young patient with stroke. Bedside echocardiography expedited the diagnosis, patient care, and treatment.