Does this patient with thrombotic thrombocytopenic purpura have a cardiac involvement?
A 53-year-old man was admitted to the intensive care unit (ICU) for thrombotic microangiopathy (TMA). His past medical history included hypercholesterolemia and smoking. In addition to profound thrombocytopenia (7 × 109/l) and mechanical haemolytic anemia (positive schistocytes on the blood smear and negative direct antiglobulin test), he exhibited diffuse purpura on his lower extremities. There was neither chest pain nor clinical features of congestive heart failure, and the electrocardiogram (ECG) was normal. However, cardiac troponin I measurement was 0.45 µg/l. The diagnosis of thrombotic thrombocytopenic purpura (TTP) was immediately suspected, and plasma exchange (PEX) and steroids were initiated within 3 h of ICU admission. The diagnosis was confirmed by undetectable ADAMTS-13 activity on a sample drawn prior to the first PEX. On day 2, the patient presented with atrial fibrillation. An echocardiogram revealed global left ventricular hypokinesis with a...
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