Arterial thromboembolism in a young woman with occult dilated cardiomyopathy

An acute dilated cardiomyopathy may present with vague symptoms including fatigue and malaise, which may delay the diagnosis until signs and symptoms of systolic heart failure develop. Left ventricular thrombus and arterial thromboembolism are rare complications of acute dilated cardiomyopathy. We present a case of a young Caucasian woman presenting with acute leg ischemia secondary to femoral artery thromboembolism associated with a previously undiagnosed acute dilated cardiomyopathy with severe systolic heart failure and a large left ventricular thrombus. Her prothrombotic state was refractory to heparin therapy and surgical vascular intervention. She eventually required leg amputation for recurrent limb ischemia with gangrene and thrombus extraction from the left ventricle. Risk factors for her prothrombotic state included the acute, dilated cardiomyopathy, use of a hormonal contraceptive agent, obesity, smoking, and a heterozygous Factor II (Prothrombin) G20110A mutation.