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A 78-year-old female patient presented with a 1-month history of cold pulseless lower limbs consistent with ischaemia. She was diabetic and hypertensive. No popliteal or pedal pulses could be palpated. Electrocardiography revealed atrial fibrillation (AF).Echocardiography revealed that thrombus in atrial side of the mitral valve (Figure 1), with moderate mitral regurgitation, mild left atrial enlargement (43 mm), and normal left ventricular systolic function. Lower extremity arterial Doppler revealed occluded bilateral superficial femoral arteries. Revascularisation was recommended but the patient refused. Warfarin and enoxaparin was started but she did not use them regularly. Figure 1. Transthoracic echocardiographic images (A) parastenal (B) apical approach LV: left ventriculi, LA: left atria, Ao: aorta, Thr: thrombi. A month later bilateral necrosis below knee gangrene developed and amputation was performed by orthopaedic surgeons (Figure 2). No thrombus was observed on the echocardiography performed at this time. The objective for presenting this case was to remind once again that AF is not an innocent disease and may lead to severe limb ischaemia. We recommend that all AF patients should be evaluated about necessity of anticoagulation and those presenting with thromboembolic symptoms to be screened by echocardiography to diagnose left atrial thrombus. Figure 2. Bilateral necrosis beneath the knee

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Suleyman Ercan, Cardiology Department, Gaziantep University, School of Medicine, Gaziantep, Turkey; Adnan Dogan, Cardiology Department, Osmaniye State Hospital, Osmaniye, Turkey; Vedat Davutoglu, Cardiology Department, Gaziantep University, School of Medicine, Gaziantep, Turkey; Gokhan Altunbas, Cardiology Department, Kilis State Hospital, Kilis, Turkey

Acknowledgements

Correspondence

Suleyman Ercan, MD, Gaziantep University, School of Medicine, Department of Cardiology, 27310, Gaziantep, Turkey.

Correspondence Email

myuce@gantep.edu.tr

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

A 78-year-old female patient presented with a 1-month history of cold pulseless lower limbs consistent with ischaemia. She was diabetic and hypertensive. No popliteal or pedal pulses could be palpated. Electrocardiography revealed atrial fibrillation (AF).Echocardiography revealed that thrombus in atrial side of the mitral valve (Figure 1), with moderate mitral regurgitation, mild left atrial enlargement (43 mm), and normal left ventricular systolic function. Lower extremity arterial Doppler revealed occluded bilateral superficial femoral arteries. Revascularisation was recommended but the patient refused. Warfarin and enoxaparin was started but she did not use them regularly. Figure 1. Transthoracic echocardiographic images (A) parastenal (B) apical approach LV: left ventriculi, LA: left atria, Ao: aorta, Thr: thrombi. A month later bilateral necrosis below knee gangrene developed and amputation was performed by orthopaedic surgeons (Figure 2). No thrombus was observed on the echocardiography performed at this time. The objective for presenting this case was to remind once again that AF is not an innocent disease and may lead to severe limb ischaemia. We recommend that all AF patients should be evaluated about necessity of anticoagulation and those presenting with thromboembolic symptoms to be screened by echocardiography to diagnose left atrial thrombus. Figure 2. Bilateral necrosis beneath the knee

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Suleyman Ercan, Cardiology Department, Gaziantep University, School of Medicine, Gaziantep, Turkey; Adnan Dogan, Cardiology Department, Osmaniye State Hospital, Osmaniye, Turkey; Vedat Davutoglu, Cardiology Department, Gaziantep University, School of Medicine, Gaziantep, Turkey; Gokhan Altunbas, Cardiology Department, Kilis State Hospital, Kilis, Turkey

Acknowledgements

Correspondence

Suleyman Ercan, MD, Gaziantep University, School of Medicine, Department of Cardiology, 27310, Gaziantep, Turkey.

Correspondence Email

myuce@gantep.edu.tr

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

A 78-year-old female patient presented with a 1-month history of cold pulseless lower limbs consistent with ischaemia. She was diabetic and hypertensive. No popliteal or pedal pulses could be palpated. Electrocardiography revealed atrial fibrillation (AF).Echocardiography revealed that thrombus in atrial side of the mitral valve (Figure 1), with moderate mitral regurgitation, mild left atrial enlargement (43 mm), and normal left ventricular systolic function. Lower extremity arterial Doppler revealed occluded bilateral superficial femoral arteries. Revascularisation was recommended but the patient refused. Warfarin and enoxaparin was started but she did not use them regularly. Figure 1. Transthoracic echocardiographic images (A) parastenal (B) apical approach LV: left ventriculi, LA: left atria, Ao: aorta, Thr: thrombi. A month later bilateral necrosis below knee gangrene developed and amputation was performed by orthopaedic surgeons (Figure 2). No thrombus was observed on the echocardiography performed at this time. The objective for presenting this case was to remind once again that AF is not an innocent disease and may lead to severe limb ischaemia. We recommend that all AF patients should be evaluated about necessity of anticoagulation and those presenting with thromboembolic symptoms to be screened by echocardiography to diagnose left atrial thrombus. Figure 2. Bilateral necrosis beneath the knee

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Suleyman Ercan, Cardiology Department, Gaziantep University, School of Medicine, Gaziantep, Turkey; Adnan Dogan, Cardiology Department, Osmaniye State Hospital, Osmaniye, Turkey; Vedat Davutoglu, Cardiology Department, Gaziantep University, School of Medicine, Gaziantep, Turkey; Gokhan Altunbas, Cardiology Department, Kilis State Hospital, Kilis, Turkey

Acknowledgements

Correspondence

Suleyman Ercan, MD, Gaziantep University, School of Medicine, Department of Cardiology, 27310, Gaziantep, Turkey.

Correspondence Email

myuce@gantep.edu.tr

Competing Interests

Contact diana@nzma.org.nz
for the PDF of this article

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