A Sticky Situation: Aortic Valve Thrombus in Patient with Anti-Phospholipid Antibody Syndrome and Immune Thrombocytopenia

A 29-year-old woman of south Asian descent with past medical history of well-controlled immune thrombocytopenia on Eltrombopag and MYH9 (myosin heavy chain) mutation presented to the emergency department with four days of diffuse chest pain and cough. Her blood pressure was 133/88mmHg with a pulse of 92 beats per minute. There was a 3/6 systolic murmur at the right upper sternal border. The remainder of her physical exam was unremarkable. Platelet count was 81 K/μL. A transthoracic echocardiogram showed a severely dilated left ventricle, moderately reduced left systolic function with an LV ejection fraction (LVEF) of 30-34%, and mild concentric left ventricular hypertrophy.