Biventricular thrombi

A male patient over 50 years presented to a hospital with complaints of swelling, pain, and blue-purple discolouration of the legs for 2 days. He had a respiratory tract infection with progressive pain two weeks ago. On examination, he was tachycardic, had a blood pressure of 150/70 mmHg, and gangrene of all toes. His echocardiogram demonstrated biventricular thrombi and an LV ejection fraction of 20%. Contrast-enhanced CT scan of his chest confirmed pulmonary embolism along with large-volume biventricular thrombi (figure). His laboratory investigations revealed leucocytosis, thrombocytopenia, high creatine kinase, C reactive protein, D-dimer, and high-sensitivity troponin levels. He had a high risk of heart failure, so surgical removal of the ventricular thrombi was denied. His cardiac catheterisation showed a thrombus in the left anterior descending artery, suggesting a chronic occlusion of days to weeks. He gradually developed an acute anterior STEMI complicated by ventricular tachycardia arrest and died after 7 days.