Authors

• Andreja Čleković-Kovačić — Bjelovar General Hospital, Bjelovar, Croatia — ORCID: 0000-0002-4532-3597
• Renata Ivanac Janković — Bjelovar General Hospital, Bjelovar, Croatia — ORCID: 0000-0003-4949-3953
• Ivana Petrović Juren — Bjelovar General Hospital, Bjelovar, Croatia — ORCID: 0000-0002-2793-3455
• Vlasta Soukup Podravec — Bjelovar General Hospital, Bjelovar, Croatia — ORCID: 0000-0002-4605-0068
• Sandra Prša — Bjelovar General Hospital, Bjelovar, Croatia — ORCID: 0000-0001-9639-3918
• Kristina Milevoj Križić — Bjelovar General Hospital, Bjelovar, Croatia — ORCID: 0000-0003-2115-3076
• Iva Ladić — Bjelovar General Hospital, Bjelovar, Croatia — ORCID: 0000-0003-0124-5256
• Gabrijela Bašković — Bjelovar General Hospital, Bjelovar, Croatia — ORCID: 0000-0002-5413-873X

Abstract

**Introduction:** Inflammation is the dynamic process of defense made of chronological changes which are repercussions of the body on injury or infection, It is made of complex biological and biochemical reactions which includes crucial cells of the immune system and many lots of biological mediators stimulated with mechanical injuries, toxins, infections and reaction hypersensitivity. Because of the disorders of the homeostatic system it is bigger probability of appearing thromboembolic incidence especially in patients with some disorders. Dilated cardiomyopathy is disease with structural and functional changes of heart muscle. (1-6) In the following case report the 43-year-old male with earlier known secondary dilated cardiomyopathy who presented with a pneumonia and thrombus in left and right ventricle. **Case report**: 44-year-old male patient with earlier known secondary dilated cardiomyopathy (post myocardial; from 2014) was hospitalized because of right pneumonia and heart failure. He was presented with dyspnea and chest pain and with elevated inflammation markers, D-dimer, and NT-proBNP). Because of chest pain we did the CT pulmonary angiography and we exclude pulmonary embolism. Echocardiography showed the dilatated (EDD 75 mm) left ventricle (LV) with reduced EF 25-28%. In akinetic apical part of the LV we noticed the thrombus (7x6 mm) (**Figure 1**). The right ventricle (RV) was dilatated (40 mm) with reduced contractility: TAPSE 13 mm, and RVEF around 30%. In the RV we noticed thrombus (32x22 mm) (**Figure 2**). With the TEE we confirm the formation of the thrombus (20x30 mm) in the apical part of the LV. With the antibiotic therapy (piperacillin with tazobactam and then with azithromycin and tetracycline and with the other medicaments) we achieve regression of pneumonia and resolution of symptoms of heart failure. In the further processing (in the tertial institution) with the cardiac magnetic resonance we prove that the formation in the left and the right heart was thrombus. The patient was prepared for heart transplantation. FIGURE 1. Thrombus in the left ventricle. FIGURE 2. Thrombus in the right ventricle. **Conclusion**: Every additional disease can complicate the earlier known heart disease especially with inflammation which has the procoagulant activity that encourages appearing thrombus. We must be more careful in the patient with some of the heart disease so that we do not predict it.

Keywords

dilated cardiomyopathy, pneumonia, thrombus, echocardiography

DOI

Literature

1. Alkhedaide AQ. Anti-inflammatory Effect of Juniperus Procera Extract in Rats Exposed to Streptozotocin Toxicity. Antiinflamm Antiallergy Agents Med Chem. 2019;18(1):71–9. https://doi.org/10.2174/1871523018666181126124336
2. Bendtzen K. The immune system and inflammatory diseases. Ugeskr Laeger. 2008 Jun 9;170(24):2110–5. https://pubmed.ncbi.nlm.nih.gov/18565290/
3. Herrington C, Hall PA. Molecular and cellular themes in inflammation and immunology. J Pathol. 2008 Jan;214(2):123–5. https://doi.org/10.1002/path.2303
4. Schmid-Schönbein GW, Hugli TE. A new hypothesis for microvascular inflammation in shock and multiorgan failure: self-digestion by pancreatic enzymes. Microcirculation. 2005 Jan-Feb;12(1):71–82. https://doi.org/10.1080/10739680590896009
5. Parker AB, Yusuf S, Naylor CD. The relevance of subgroup-specific treatment effects: the Studies Of Left Ventricular Dysfunction (SOLVD) revisited. Am Heart J. 2002 Dec;144(6):941–7. https://doi.org/10.1067/mhj.2002.126446
6. Ronco C, Cicoira M, McCullough PA. Cardiorenal syndrome type 1: pathophysiological crosstalk leading to combined heart and kidney dysfunction in the setting of acutely decompensated heart failure. J Am Coll Cardiol. 2012 Sep 18;60(12):1031–42. https://doi.org/10.1016/j.jacc.2012.01.077