Intracardiac thrombi in pulmonary embolism of a priori non high risk: therapeutic dilemma

Abstract

Pulmonary embolism (PE) of a priori non high risk according to ESC guidelines, but coexisting with intracardiac thrombi is
potentially a life threatening disease. The recommendations regarding therapy in such situations are not clear. We report two
cases of PE with coexisting intracardiac thrombi. The 74 year-old woman was admitted after previous cardiac arrest in the
course of PE with the presence of intracardiac thrombi in right ventricle. Due to lack of clinical improvement during heparin
administration she was treated with thrombolysis. The 72 year-old obese woman with hypertension, diabetes and previous
stroke with right-sided paresis was admitted after 2 episodes of loss of consciousness, with intracardiac thrombus in both
right and left heart. Due to contraindications to both surgery and thrombolysis, she was treated with heparin. Both women
recovered successfully. These cases illustrate the importance of individual treatment strategy.