# A Rare Case of Left Ventricular Thrombus in a Normal Heart in a Patient With Factor V Leiden Disease

## TL;DR

A rare case shows a left ventricular thrombus in a normal heart of a patient with Factor V Leiden disease, highlighting the importance of timely diagnosis and anticoagulation.

## Contribution

This case report highlights the rare occurrence of left ventricular thrombus in a normal heart associated with Factor V Leiden disease.

## Key findings

- A 60-year-old patient with Factor V Leiden disease had a left ventricular thrombus despite normal heart function.
- Timely diagnosis and anticoagulation therapy prevented further serious thromboembolic events.
- The case emphasizes that normal heart size and function do not rule out left ventricular thrombosis.

## Abstract

Left ventricular thrombus (LVT) is mostly associated with anterior wall myocardial infarction and reduced ejection fraction. It can also be associated with cardiomyopathy, myocarditis, and hypercoagulable states such as cancer, antiphospholipid syndrome, and protein C or protein S deficiency. Factor V Leiden (FVL) disease is one of the hypercoagulable states where mutant factor V is insensitive to natural anticoagulation factor protein C, and FVL disease increases the risk of peripheral thromboembolism such as pulmonary embolism (PE) and deep vein thrombosis (DVT). We report a 60-year-old female patient with a history of heterozygous factor V Leiden and a remote history of deep vein thrombosis who presented with left-sided weakness and intermittent chest pain. Computed tomography (CT) of the brain ruled out stroke, electrocardiogram (EKG) showed sinus rhythm and some new T-wave inversion, and troponin was mildly elevated. Other laboratory results were unremarkable. A transthoracic echocardiogram showed a left ventricular mass with left ventricular outflow tract (LVOT) obstruction in systole with normal systolic and diastolic function and no wall motion abnormalities. Emergent surgery proved to be a thrombus. The learning objectives of our case are that a normal-sized and functional left ventricle does not preclude left ventricular thrombosis, long-term anticoagulation therapy in patients with factor V Leiden and a first episode of thromboembolism with additional risk factors may prevent further serious thromboembolic event, and timely diagnosis and treatment of cardiac thrombosis may reduce morbidity and mortality.