Abstract 14631: A Perfect Storm: Alcoholic Cardiomyopathy, Influenza B and the Battle Against Biventricular Thrombi and Pulmonary Embolism

Introduction: Biventricular thrombi (BT) are a rare occurrence in clinical practice and when they occur in alcoholic dilated cardiomyopathy (ADCM), they are a complication of this condition. Secondary predisposing conditions that can promote thrombus formation include infections like Influenza B. Herein, we report a rare case of ADCM and influenza B propagating the development of biventricular thrombi and pulmonary embolism.

Case Presentation: A 47-year-old healthy gentleman with a history of tobacco, marujuana and alcohol abuse presented with shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, non-productive cough, fevers and bilateral lower extremity swelling. Initial vitals were significant for tachycardia and slightly elevated blood pressure. On examination, the patient had decreased breath sounds in the right lower lobe with rales and trace lower extremity edema. Initial labs revealed elevated BNP, High-sensitivity troponin and d-dimer. Rapid influenza B was positive. Chest x-ray showed pleural effusion and CT angiogram chest revealed filling defect in the segmental and subsegmental branches of the right pulmonary artery. Echocardiogram revealed biventricular thrombi and LVEF of 10-15% with global LV hypokinesis. He was treated with oseltamivir, enoxaparin and was started on guideline directed medical therapy.

Discussion: BT formation can occur in heart failure with reduced ejection fraction. ADCM induces LV dilation which creates a stagnant environment conducive to thrombus development. Influenza B can cause a prothrombotic state due to endovascular injury by proinflammatory mediators. Due to advanced diagnostic techniques, the incidence of BT has increased however, they remain a significant challenge due to embolization risks. This is the first case that highlights that patients with ADCM in combination with influenza B are predisposed to hypercoagulable states inducing fatal BT formation thus, prompt recognition is vital.