Hypertensive Crisis and Left Ventricular Thrombi after an Upper Respiratory Infection during the Long-term Use of Oral Contraceptives

Intern Med. 2016;55(1):83-8. doi: 10.2169/internalmedicine.55.5500. Epub 2016 Jan 1.

Abstract

A 34-year-old woman who had been using oral contraceptives for 10 years developed hypertensive crisis with papilloedema after an upper respiratory infection. Laboratory data showed hyperreninemic hyperaldosteronism and elevated levels of fibrinogen, fibrin, and fibrinogen degradation products. Echocardiography demonstrated two masses (18 mm) in the left ventricle. On the fourth hospital day, cerebral infarction, renal infarction, and upper mesenteric artery occlusion suddenly occurred despite the blood pressure being well-controlled using anti-hypertensive drugs. Echocardiography revealed the disappearance of the left ventricular masses, which suggested left ventricular thrombi. Cessation of the contraceptives and administration of heparin, warfarin, and anti-platelets drugs improved her general condition.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antihypertensive Agents / administration & dosage*
  • Blood Pressure
  • Contraceptives, Oral / adverse effects
  • Echocardiography
  • Female
  • Fibrin Fibrinogen Degradation Products
  • Fibrinogen
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / pathology*
  • Heparin
  • Humans
  • Hypertension / drug therapy
  • Hypertension / physiopathology*
  • Respiratory Tract Infections / drug therapy
  • Respiratory Tract Infections / physiopathology*
  • Thrombosis / diagnosis*
  • Thrombosis / drug therapy
  • Thrombosis / physiopathology
  • Treatment Outcome
  • Warfarin / therapeutic use

Substances

  • Antihypertensive Agents
  • Contraceptives, Oral
  • Fibrin Fibrinogen Degradation Products
  • Warfarin
  • Fibrinogen
  • Heparin