Multiple biventricular thrombi in a patient with alcoholic c
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As a primary cause, intracardiac thrombi are seen in a variety of cardiac conditions such as acute anterior myocardial infarctions and dilated cardiomyopathy. However, there are secondary predisposing conditions that increase the risk of clot formation in normally functioning ventricles. Migration or embolization of thrombus produced elsewhere, such as pulmonary thrombo-embolism, may occur at times. However, the current coronavirus disease 2019 (COVID-19) pandemic has resulted in a variety of intracardiac or extracardiac thrombi formations due to systemic inflammation and activation of the clotting system.

A 48-year-old male laborer, a known chronic alcoholic was admitted with recent onset of breathlessness on exertion, NYHA class III, and a 2-week history of paroxysmal nocturnal dyspnea (PND). There were no risk factors, such as hypertension or diabetes, and there was no history of dilated cardiomyopathy or sudden cardiac death in the family. He has consumed 14–16 standard drinks (2–3 oz ) of illicit liquor per week for the past 15 years. On examination, his vital parameters recorded heart rate of 112/beats per minutes, blood pressure of 100/58 mm Hg, respiratory rate of 16/min, and temperature of 37.2 °C. Also, there were increased jugular venous pulsations with prominent v-waves. The cardiac examination demonstrated increased parasternal pulsations with downward and laterally displaced cardiac apex to the 6th intercostal space. There was a gallop rhythm with no murmur. Per abdominal examination demonstrated tender hepatomegaly with normal bowel sounds. Four weeks previously, he had a fever with chills and rigors, a dry cough, generalized weakness, and a lack of appetite, and was diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) . He did not experience any breathlessness, orthopnea, or PND episodes. He sought advice from a local general practitioner and stayed in quarantine at home. Laboratory parameters showed elevated levels of D-dimer, C-reactive protein, interleukin-6, ferritin, and N-terminal prohormone B-type natriuretic peptide (Table 1). Since his D-dimer levels were initially elevated, he was placed on rivaroxaban 10 mg once daily for thromboprophylaxis by a local practitioner. He also was prescribed oral medications such as dexamethasone (6 mg once a day) for 1 week, doxycycline 100 mg twice daily for 5 days, ivermectin 12 mg once daily for 3 days, vitamin C, and zinc. Mild cardiomegaly and bilateral interstitial infiltrates were seen on a chest X-ray. Computed tomography (CT) of the chest revealed bilateral peripheral ground glass opacities (CORADS -4).

Significant systolic dysfunction is unusual, especially in people with prolonged alcoholism.
The hypercoagulable condition of coronavirus disease 2019 (COVID-19), combined with myocardial damage secondary to alcohol, can result in extensive intracardiac thrombosis.
Thrombotic manifestations in COVID-19 are associated with a high mortality rate.