Intraoperative Takotsubo Cardiomyopathy: A Case Report.

Takotsubo cardiomyopathy (TTC) is a rare condition associated with transient akinesia of apical segments and hyperkinesia of basal segments of the heart. Although several mechanisms have been proposed to cause direct and indirect myocardial damage owing to catecholamine excess, the underlying pathophysiology remains unknown. An 18-year-old female was referred to our otorhinolaryngology outpatient clinic for a septorhinoplasty. Apart from the fear of surgery, the patient had no other health issues. After the administration of local anesthesia (lidocaine and epinephrine mix), tachycardia storms occurred and soon ended with cardiac collapse. Further evaluation revealed TTC. TTC should be considered, especially in cases of treatment-resistant hemodynamic problems after cardiac resuscitation, and nurses can play a crucial role during the preanesthetic period in helping the patient cope with the stress factors related to the upcoming surgery.

Evaluation of the relationship between para-aortic adipose tissue and ascending aortic diameter using a new method.

BACKGROUND: Para-aortic adipose tissue (PAT) is the local adipose tissue that externally surrounds the aorta. It contributes significantly to aortic atherosclerosis and enlargement. Studies conducted with computed tomography and magnetic resonance have shown that individuals with aortic aneurysm had more PAT than healthy individuals. In this study, we measured PAT using transthoracic echocardiography (TTE). The aim of this study is to investigate the possible relationship of TTE measured PAT with ascending aortic width. METHODS: PAT was defined as the hypoechoic space in front of ascending aortic 2 cm above the sinotubular junction at the end of the systole. Patients were divided into 2 groups according to the presence of dilatation in the ascending aorta using Roman's classification (aortic size index, ASI). ASI of less than 21 was considered no aortic dilation and an ASI of 21 mm/m2 or greater was considered to have aortic dilation. RESULTS: A total of 321 unselected patients were divided into the ascending aortic dilatation (AAD) group (n = 96) and the normal ascending aorta diameter group (n = 225 patients). PAT was significantly higher in the AAD group compared with the non-ADD group (0.9 (0.48) vs. 0.7 (0.91) mm, p < 0.0001). Univariate and multivariate logistic regression analysis revealed that PAT (OR: 3.005, 95%CI (1.445-6.251)) were significantly associated with AAD. CONCLUSIONS: This is the first study which evaluated PAT measured by TTE. We found a significant association between PAT measured by TTE and ascending aorta width.

In-Hospital Bleeding and Mortality in Acute Coronary Syndrome Patients Treated with Tirofiban and Potent P2Y12 Inhibitors.

OBJECTIVE: In this study, we aimed to determine whether potent agents affect in-hospital bleeding and mortality compared to clopidogrel in patients with the acute coronary syndrome in whom tirofiban and P2Y12 inhibitor are used together. METHODS: Patients who were treated interventionally between 2015 and 2020 and were using tirofiban were retrospectively screened. Clinical, laboratory, and angiographic findings were obtained from the hospital database. Patients were analyzed by dividing them into clopidogrel and prasugrel/ticagrelor groups. RESULTS: Acute coronary syndrome patients (n = 227) who were treated interventionally were included in this retrospective study. Clopidogrel was given to 93 (41%), ticagrelor to 112 (49.3%), and prasugrel to 22 of the patients (9.7%). Compared to the ticagrelor/prasugrel group, the clopidogrel group was older and more were women, and the history of hypertension and previous coronary artery disease was higher (P, respectively: <.001; .001; .008; .0045). The creatinine value was higher, the basal hemoglobin was lower, and the GRACE (Global Registry of Acute Coronary Events) and CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) scores were higher (P, respectively: .026; .002; .002; <.001). The in-hospital bleeding rate was signifi- cantly higher in the clopidogrel group (P < .001). Although the in-hospital mortality rate was higher, it was not statistically significant (P = .07). Regression analysis showed that GRACE score and gender were associated with in-hospital mortality (P < .001; P=.031, respectively), and only age was associated with in-hospital bleeding (P < .001). No relationship was found with P2Y12 inhibitor. CONCLUSION: In our study, we found that the combined use of potent P2Y12 inhibitor with tiro- fiban in acute coronary syndrome patients treated interventionally was not different from the use of clopidogrel in terms of in-hospital bleeding and mortality.

Association of the Atherogenic Index of Plasma with C-Reactive Protein and Urinary Albumin Excretion in a Normotensive Nondiabetic Population.

Background: The atherogenic index of plasma (AIP) is an indicator of atherogenic dyslipidemia and is significantly associated with the development of atherosclerotic cardiovascular disease. Previous studies showing the association of AIP with C-reactive protein (CRP) and microalbuminuria included hypertensive and diabetic patients. We aimed to determine the association of AIP with CRP and albuminuria in a normotensive and nondiabetic population. Methods: The study was conducted retrospectively. Two hundred thirty-three individuals without hypertension, diabetes, cardiovascular disease, malignancy, systemic inflammatory disease, nephrological disease, and active infection were determined and included in the study. Urinary albumin excretion was calculated from the albumin-creatinine ratio in fresh spot urine [urinary albumin-creatinine ratio (UACR)]. AIP risk groups were compared in terms of clinical and laboratory findings, and the correlation between AIP and CRP and UACR was evaluated. Results: A total of 233 people, with a mean age of 45.4 years and 139 (69.7%) of whom were male, were included in the study. One hundred thirty-eight (59.2%) individuals were found to be in the low-risk group, 29 (12.5%) in the medium-risk group, and 66 (28.3%) in the high-risk group, according to the AIP value. CRP and UACR were not different between the AIP risk groups (P: 0.141 and 0.441, respectively). A mild correlation was found between AIP and CRP (r: 0.192; P: 0.003), but no correlation was found between AIP and UACR (r: 0.086; P: 0.193). The stepwise linear regression analysis with model adjusted for possible confounders and AIP revealed that only body mass index was a significant predictor of CRP (ß: 0.308; P < 0.001), while only systolic blood pressure was a significant predictor of UACR (ß: 0.19; P: 0.004), but AIP was not. Conclusions: AIP was not associated with CRP and UACR in normotensive and nondiabetic individuals. This finding suggests that the relationship found in previous studies is related to the presence of hypertension or diabetes rather than the AIP.

Association of Morning Surge and Postexercise Heart Rate and Blood Pressure Recovery.

INTRODUCTION: The autonomic nervous system plays an active role in the regulation of early morning blood pressure (BP) and BP/pulse regulation in the treadmill exercise test (TET). AIM: We evaluated the relationship between BP/pulse changes during TET and morning blood pressure surge (MS). METHODS: Patients who underwent ambulatory blood pressure measurement (ABPM) and TET in the same visit between 2017 and 2020 were evaluated retrospectively. Patients with previously diagnosed hypertension and/or using antihypertensives and office BP ≥ 140/90 were excluded from the study.MS values and dipping percentage were calculated from ABPM data. The patients were analyzed by dividing them into two groups according to the MS median, and BP/pulse values during exercise and recovery periods were compared in these groups. RESULTS: 202 patients [median age 45 (39-51), male 134 (66.3%)] were included in the study. MS median was 18.5 (10.75-27) mmHg. TET recovery period 3rd-min systolic blood pressure (RSBP) was higher in the group with high MS (p: 0.017). Systolic and diastolic dipping percentages were higher in the group with higher MS (p: 0.015, p: 0.040, respectively). Peak systolic and diastolic BP, RSBP, and recovery 3rd min diastolic BP were positively correlated with MS (p < 0.05, for all). Additionally, an independent relationship was observed between RSBP and MS (ß: 0.205, p: 0.028). CONCLUSION: We found an independent association between RSBP and MS. Increased RSBP may be associated with target organ damage and cardiovascular events such as MS.

A new and simple parameter for diagnosis pulmonary edema: Expiratory air humidity.

PURPOSE: Acute pulmonary edema is characterized by increased levels of fluid in the interstitial and alveolar space of the lung and requires emergency treatment. In acute pulmonary edema, the amount of fluid in the intra-alveolar, interstitial space, and pleural space vary considerably and this fluid will evaporate in different amounts compared to the physiological fluid. The aim of this study was to compare the humidity rates of expiratory air measured before and after pulmonary edema induced by α-naphthylthiourea (ANTU) in rats. METHODS: The study included twenty healthy adult rats divided equally into a healthy control group and a pulmonary edema group. Pulmonary edema was induced by administering ANTU intraperitoneally in the rats in the study group. Humidity, temperature, lung weight, pleural effusion, and histopathological changes in the respiratory system due to pulmonary edema were examined in the ANTU group. Control measurments were taken before administration of ANTU and again 4 h after administration of ANTU when lung damage was considred to be at maximum levels. RESULTS: Mean expiratory air humidity was 71.22±3.59% before ANTU and 56.28±3.94% after administration of ANTU. The mean humidity difference of -14.94±5.96% was considered statistically different (p = 0.01). CONCLUSION: Humidity rate in expiratory air was significantly lower in rats with acute pulmonary edema compared to healthy rats. This result supports the hypothesis that humidity in expiratory air can be considered an important parameter in patients during clinical are follow-up for pulmonary edema.

New perspective on fatigue in hemodialysis patients with preserved ejection fraction: diastolic dysfunction : Fatigue and diastolic dysfunction.

The relationship between diastolic dysfunction and fatigue in hemodialysis patients with preserved ejection fraction is unknown. In this context, the objective of this study is to assess fatigue using the relevant scales and to demonstrate its relationship with diastolic dysfunction. The patients who underwent hemodialysis were evaluated prospectively. Patients' fatigue was assessed using the Visual Analogue Scale to Evaluate Fatigue Severity (VAS-F). The echocardiographic works were performed as recommended in the American Society of Echocardiography guidelines. A total of 94 patients [mean age 64.7 ± 13.5 years, 54 males (57.4%)] were included in the study. The median VAS-F score of these patients was 68.5 (33.25-91.25), and they were divided into two groups according to this value. Peak myocardial velocities during early diastole (e') and tricuspid annular plane systolic excursion (TAPSE) values were found to be significantly lower in the group with high VAS-F scores, whereas the early diastolic flow velocities (E)/e' ratio and pulmonary artery peak systolic pressures (PAP) were found to be significantly higher (p < 0.05, for all). E/e' ratio (r 0.311, p 0.002) and PAP (r 0.281, p 0.006) values were found to be positively correlated with the VAS-F score, as opposed to the TAPSE (r - 0.257, p 0.012) and e' (r - 0.303, p 0.003) values, which were found to be negatively correlated with the VAS-F score. High fatigue scores in hemodialysis patients may be associated with diastolic dysfunction. In addition, in our study, we determined the correlation of VAS-F score with E/e' ratio, PAP and TAPSE.

Aortic arch calcification: a novel parameter for prediction of masked hypertension.

BACKGROUND: Masked hypertension is directly related to increased cardiovascular morbidity and mortality but remains underdiagnosed in clinical practice. The aim of the study was to search the role of aortic arch calcification (AAC) in the diagnosis of masked hypertension. METHODS AND RESULTS: Among the patients who underwent ambulatory blood pressure monitoring (ABPM) in our clinic, those with office blood pressure (OBP) <140/90 mmHg were included in the study population. According to OBP, they were divided into two groups as normal (<130/85 mmHg) and high normal (130-139/85-89 mmHg) OBP groups. Subjects were also investigated for the presence of masked hypertension with ABPM and searched in masked hypertension and control groups. Masked hypertension was defined as in the latest 2017 ACC/AHA Hypertension guideline and was diagnosed as the daytime BP ≥ 135/85 mmHg and nighttime BP ≥ 120/70 mmHg. AAC was evaluated on direct X-ray telecardiography. Diagnosis of masked hypertension was searched depending on the presence of AAC and OBP measurements as well. A total of 216 volunteers were involved in the study [mean age 45.2 ± 12.2 years; female gender 120 (55.5%)]. One hundred ten volunteers (50.9%) had masked hypertension according to the ABPM. AAC was significantly more common in the masked hypertension group (44.5% vs. 26.4%) (P = 0.005). AAC had a positive predictive value of 79% in those with high normal OBP in the diagnosis of masked hypertension, and also AAC had a negative predictive value of 74% in those with normal OBP. CONCLUSION: AAC can be used as a reliable diagnostic tool to exclude and predict masked hypertension during office examination.

Could aortic arch calcification help in detection of hypertensive retinopathy?

OBJECTIVE: Hypertension-induced end-organ damage is one of the important determinants of morbidity and mortality in patients with hypertension. All types of hypertension-induced end-organ damages start with vascular damage. Vascular calcification is a marker of vascular damage and aortic arch calcification (AAC) is one of the easily identifiable types of vascular calcification. We hypothesized that AAC predicts retinopathy in hypertensive patients. METHODS: Consecutive hypertensive patients without diabetes mellitus were included. Chest radiography in the posterior-anterior was used to assess the presence of AAC. All patients underwent ophthalmologic examination for retinopathy. RESULTS: We included 495 hypertensive patients in this study. Of these, 306 (62%) had hypertensive retinopathy. Patients with hypertensive retinopathy had significantly higher prevalence of AAC as compared to the patients without hypertensive retinopathy (88% vs. 22%, P < 0.001). We found a strong and positive correlation between hypertensive retinopathy and AAC grades (r = 639, P < 0.001). Receiver operator characteristics curve analysis yielded a strong predictive ability of AAC for the presence of hypertensive retinopathy [area under curve = 0.814, 95% confidence interval (CI): 0.775-0.853, P < 0.0001]. In multivariate logistic regression analysis, presence of AAC [odds ratio (OR) 13.128; CI: 7.894-21.832] and serum glucose levels (OR 1.020; CI: 1.003-1.037) were strongly and independently associated with hypertensive retinopathy. CONCLUSION: Presence of AAC on chest radiograph is strongly and independently associated with retinopathy in nondiabetic hypertensive patients. This simple, inexpensive and widely available tool may help in early detection of retinopathy in patients with hypertension.

Aortic Arch Calcification on Routine Chest Radiography is Strongly and Independently Associated with Non-Dipper Blood Pressure Pattern / A Calcificação no Arco Aórtico na Radiografia de Tórax de Rotina está Forte e Independentemente Associada ao Padrão Não-Dipper de Pressão Arterial

Abstract Background: Non-dipper blood pressure (NDBP) is one of the important causes of hypertension-related target organ damage and future cardiovascular events. Currently, there is no practical tool to predict NDBP pattern. Objectives: The aim of this study was to investigate the relationship between aortic arch calcification (AAC) on chest radiography and NDBP pattern. Methods: All patients referred for ambulatory BP monitoring test were approached for the study participation. NDBP was defined as the reduction of ≤10% in nighttime systolic BP as compared to the daytime values. AAC was evaluated with chest radiography and inter-observer agreement was analyzed by using kappa statistics. Univariate and multivariate logistic regression analysis was conducted to assess the association of AAC and NDBP pattern. A 2-tailed p-value < 0.05 was considered statistically significant. Results: A total of 406 patients (median age: 51.3) were included. Of these, 261(64%) had NDBP pattern. Overall, the prevalence of AAC was 230 (57%). Non-dipper group had significantly higher prevalence of AAC (70% vs. 33%, p < 0.0001) as compared to the dipper group. Presence of AAC was a strong and independent predictor of NDBP pattern (OR 3.919, 95%CI 2.39 to 6.42) in multivariate analysis. Conclusions: Presence of AAC on plain chest radiography is strongly and independently associated with the presence of NDBP pattern.

Resumo Fundamento: A pressão arterial não-dipper é uma das causas mais importantes de lesão de órgão-alvo da hipertensão e de eventos cardiovasculares futuros. Atualmente, não há uma ferramenta prática para prever o padrão não-dipper de pressão arterial. Objetivos: O objetivo deste estudo foi investigar a relação entre a calcificação no arco aórtico detectada no raio de tórax e o padrão não-dipper de pressão arterial. Métodos: Todos os pacientes encaminhados para monitorização ambulatorial da pressão arterial foram abordados para participação no estudo. A pressão arterial não-dipper foi definida como a redução de ≤10% da pressão arterial sistólica noturna quando comparada com os valores diários. A calcificação no arco aórtico foi avaliada através de radiografia do tórax e a concordância interobservador foi analisada utilizando a estatística kappa. Análises de regressão logística uni e multivariada foram realizadas para avaliar a associação entre a calcificação no AA e o padrão PADV. Valores de p bicaudais < 0,05 foram considerados estatisticamente significativos. Resultados: Ao todo, 406 pacientes (idade mediana: 51,3) foram incluídos. Desses, 261(64%) apresentavam padrão não-dipper de pressão arterial. De modo geral, a prevalência de calcificação no arco aórtico foi de 230 (57%). O grupo não-dipper apresentou prevalência significativamente maior de calcificação no arco aórtico (70% vs. 33%, p < 0,0001) em relação ao grupo dipper. A presença de calcificação no arco aórtico foi um preditor forte e independente de padrão não-dipper de pressão arterial (OR = 3,919; IC: 95% 2,39-6,42) em análise multivariada. Conclusões: A presença de calcificação no arco aórtico em raio-x de tórax simples está forte e independentemente associada à presença de padrão não-dipper de pressão arterial.

Aortic Arch Calcification on Routine Chest Radiography is Strongly and Independently Associated with Non-Dipper Blood Pressure Pattern.

BACKGROUND: Non-dipper blood pressure (NDBP) is one of the important causes of hypertension-related target organ damage and future cardiovascular events. Currently, there is no practical tool to predict NDBP pattern. OBJECTIVES: The aim of this study was to investigate the relationship between aortic arch calcification (AAC) on chest radiography and NDBP pattern. METHODS: All patients referred for ambulatory BP monitoring test were approached for the study participation. NDBP was defined as the reduction of ≤10% in nighttime systolic BP as compared to the daytime values. AAC was evaluated with chest radiography and inter-observer agreement was analyzed by using kappa statistics. Univariate and multivariate logistic regression analysis was conducted to assess the association of AAC and NDBP pattern. A 2-tailed p-value < 0.05 was considered statistically significant. RESULTS: A total of 406 patients (median age: 51.3) were included. Of these, 261(64%) had NDBP pattern. Overall, the prevalence of AAC was 230 (57%). Non-dipper group had significantly higher prevalence of AAC (70% vs. 33%, p < 0.0001) as compared to the dipper group. Presence of AAC was a strong and independent predictor of NDBP pattern (OR 3.919, 95%CI 2.39 to 6.42) in multivariate analysis. CONCLUSIONS: Presence of AAC on plain chest radiography is strongly and independently associated with the presence of NDBP pattern.

Relationship between ST-Segment Shifts in Lead aVR and Coronary Complexity in Patients with Acute Coronary Syndrome.

BACKGROUND: ST-segment shifts in lead aVR are associated with increased coronary atherosclerosis. However, there is insufficient data about the relationship between ST-segment shifts in lead aVR and coronary complexity. The aim of this study was to investigate this relationship. METHODS: This prospective, observational study included 236 patients with acute coronary syndrome who underwent coronary angiography. Electrocardiograms on presentation were reviewed in terms of ST-segment shifts in lead aVR. Inter-observer agreement was analyzed using kappa statistics for the presence of aVR lead ST segment shifts. The patients were divided into two groups according to their Sx scores (≤ 22 and > 22). RESULTS: The mean age of the study population was 62.19 ± 12 years. Eighty-seven patients (37%) had complex coronary artery disease as defined by intermediate-high Sx scores, and 130 patients (55%) had ST-segment shifts in lead aVR. In multivariate logistic regression analysis, ST-segment elevation or depression ≥ 1 mm were independently associated with intermediate-high Sx scores. CONCLUSIONS: In patients with acute coronary syndrome, the presence of ST-segment elevation or depression ≥ 1 mm in lead aVR may indicate coronary complexity.

A strong and reliable indicator for early postoperative major cardiac events after elective orthopedic surgery: Aortic arch calcification.

BACKGROUND: Cardiovascular events after orthopedic surgery may result in mortality. Therefore, predictors of early cardiovascular events after elective orthopedic surgery are required. AIM: The aim of this study is to investigate the relationship between aortic arch calcification and 30-day major adverse cardiac events following elective orthopedic surgery. METHODS: Patients who had undergone orthopedic surgery were screened. Preoperative detailed anamnesis was taken. Echocardiography and standard chest x-ray were performed.Patients were followed in terms of perioperative 30-days major cardiac events and were classified into two groups according to development of perioperative major adverse cardiac events.Aortic arch calcification was evaluated by two cardiologists, blinded to study findings and was graded as 0 to 3 on chest x-ray. RESULTS: A total of 1060 patients were approached for the study participation. Of these 714 were included in the study (mean age: 70.43, 65% female). Cardiovascular events occurred in 33 patients. As compared to the patients without cardiac events, the prevalence of aortic arch calcification, coronary artery disease, hypertension, and smoking were higher in patients with cardiac events. In addition, Lee index, left ventricular end-systolic, end-diastolic and left atrial diameter were significantly higher, GFR values were significantly lower in the group with cardiac events.Multivariate regression analysis showed that smoking (OR 5.031, 95% CI 1.602 to 15.794), presence of hypertension (OR 5.133, 95% CI 1.297 to 20.308) and aortic arch calcification (OR 6.920, 95% CI 3.890 to 12.310) are independent predictors of major cardiac events within 30-day of elective orthopedic surgery. CONCLUSIONS: Presence of aortic arch calcification is associated with development of major cardiac events within 30-days after elective orthopedic surgery.

Development of Pacemaker Lead Thrombosis in a Patient with Atrial Fibrillation during Apixaban Treatment.

Apixaban was introduced in clinical use for nonvalvular atrial fibrillation as an alternative to warfarin. There is a dearth of information regarding apixaban use in patients suffering from atrial fibrillation with intracardiac foreign bodies such as pacemaker leads. In this report, we describe a 72-year-old female patient with a complaint of weakness in both legs of a few days' duration. She was detected to have a thrombus over the pacemaker lead and inside the left atrial appendage during apixaban treatment. After the discontinuation of apixaban and the commencement of warfarin, the thrombus was resolved. Our case is the first report to show that apixaban treatment (5 mg, twice daily) may not prevent the development of pacemaker lead thrombosis in patients with atrial fibrillation.

Relationship between Aortic Arch Calcification, Detected by Chest X-Ray, and Renal Resistive Index in Patients with Hypertension.

OBJECTIVE: Aortic arch calcification (AAC) is a surrogate marker for arterial stiffness and hypertension-related vascular damage. Renal resistive index (RRI), a renal Doppler ultrasonography parameter, is used to assess renal hemodynamics. In this study, we aimed to evaluate the relationship between RRI and AAC in patients with hypertension. METHODS: Patients with hypertension underwent a chest X-ray and re nal Doppler ultrasonography. They were divided into two groups according to RRI (group 1: RRI ≥0.70; group 2: RRI < 0.70). Two examiners, blinded to the findings of RRI, reviewed the AAC in these patients. The kappa value was detected to be 0.781 and a p value < 0.001 was considered significant. RESULTS: The study included 289 hypertensive patients (mean age 63.87 ± 11.38 years). In 53.6% (n = 155) of the study subjects, RRI was observed to be ≥0.70. Patients with RRI ≥70 were older and had more prevalent AAC as well as left ventricular hypertrophy. A multiple linear regression analysis was carried out to test whether presence of AAC significantly predicted RRI. The results of the regression analysis indicated that presence of AAC significantly predicted RRI (ß = 0.053; p < 0.001). CONCLUSIONS: A strong and independent relationship was found between AAC on chest X-ray and RRI in patients with hypertension.

Suttonella indologenes peritonitis in a patient receiving continuous ambulatory peritoneal dialysis.

Suttonella indologenes is a Gram-negative, aerobic coccobacillus of Cardiobacteriaceae family and its natural habitat is the mucous membranes of the upper respiratory system. The literature includes limited number of case reports concerning fatal endocarditis due to infection in the prosthetic heart valves caused by the aforementioned microorganism. However, there is no information on extracardiac involvement due to this microorganism. Here, we present a peritonitis case caused by Suttonella indologenes in a patient receiving continuous ambulatory peritoneal dialysis.

Newly developed left ventricular apical thrombus under dabigatran treatment.

: Left ventricular (LV) thrombi are mostly formed in the aneurysmal or akinetic segment of the LV apex. Thromboembolism to the brain is usually fatal. There is not enough information available regarding the use of these new oral anticoagulant agents in LV thrombi. In this case, we present a 56-year-old male patient who was given dabigatran (150 mg, twice a day) for paroxysmal atrial fibrillation after experiencing anterior myocardial infarction. During the use of dabigatran, thrombus formation, which was not present earlier, was observed in the LV apical aneurysm. The dabigatran treatment discontinued and warfarin was initiated and, in the follow-ups, the thrombus was observed to shrink, and complete resolution was seen 6 weeks after treatment with warfarin. The patient did not experience any thromboembolic event. Our case is the first report showing that the treatment of dabigatran 150 mg may not prevent LV thrombus development.