Small 2mm-3mm mobile clot appearing to attach to RA lead near prosthetic tricuspid

Just got some TEE results uploaded to my electronic records today.  My current cardiologist mentioned nothing of the discovery of a 2-3mm mobile vegetation (sonographer said possibly fibrin) in my right atrium where my atrial lead is brushing near my porcean tricuspid valve.  It says the mass is mobile but appears to be attached to the lead.  I am not on anticoagulants.  Is this something I should be concerned about? Clot or vegetation in my atrium sounds like a bad thing?  Or is it so small they are considering it incidental perhaps.  No mention of it was made to me verbally when results of TEE were given by primary cardio via phone two days ago.  Any advice appreciated!



by AgentX86 - 2020-09-17 20:44:25

I don't know a lot about this but a lot of things seem strange.  First, and the most important, is why your cardiologist hasn't discussed this with you (and why the sonographer would - not his job).  That makes no sense.  Again, I don't know much about this particular clot but I wonder why you're not on anticoagulants.  I guess if it's not a blood clot an anticoagulant isn't going to do anything.

Since this is on the input side of the RA, it doesn't seem to be related to the heart.  Odd but I don't know how it could be.  Since it's on the right side, it's not going to the brain (good news) but if it broke free, would almost certainly go to the lungs (not good but better than the brain).

2-3mm doesn't sound trivial to me.  I'd certainly grill the cardiologist abou this.  Education is in order.  I wouldn't ignore this even if your cardiologist does.  He probably has a good reason but I'd want to know why.


Go back to your cardiologist

by Gemita - 2020-09-18 00:36:56

Hello Asully,

We can only speculate here but my main concern would be, if this is not a tiny blood clot, could this be signs of an early infection adhering to the lead which would be very serious.  Why did they do a TEE (transesophageal echocardiogram) rather than a TTE (transthoracic echocardiogram)?  Perhaps they needed better views of this tiny mobile mass to determine its cause and significance and to differentiate between a tiny clot, tumour or the start of an infection?   

Like AgentX86, I find it strange that this was mentioned by the sonographer but no mention was made by your cardiologist, although I am unclear whether your sonographer told you this in person at the time of your TEE or if it is what you are reading from your electronic medical records? 

Let us hope that this is an insignificant finding or the appearance/size of this tiny mass has not changed since any previous imaging to suggest a serious cause but you certainly need an answer from your cardiologist.and some reassurance.  I hope for the best for you.

This was from my EMR

by asully - 2020-09-21 17:38:14

Stuck with same cardio for another week then I switch.  The TEE was done to evaluate my mitral regurgitation better, this may sound silly but I have breast implants which block some views (for example the pulmonary veins). My regurgitate jets are posteriorly directed towards the pulmonary veins.  When my current cardio called me to give echo results he only talked about my mitral valve stuff.  I ALWAYS read the reports because I have found that quite frequently the doctors don't read them fully and therefore miss things (sad but true).  So when I read this on the report I was surprised he hadn't mentioned it at all.  I called his assistant who got him to "begrudgingly" talk to me on the phone again.  I told him I wanted to make sure he was aware, and also was aware I wasn't on anticoagulants.  His response was that this "mass" ahem clot was made up of ferrin and that it wasn't a blood clot and nothing to be concerned about.  That left me still slightly confused because as far as I understand clots form when ferrin and blood cells clump together?? Maybe I am wrong, and the internet is wrong, I am not a doctor.  Anyways after months of frustrating issues with this cardio I decided I could survive the 10 days till I see the new guy, I will have him review everything.  In good news I purchased a Kardia 6L....bad news I now realize I have a lot of aryrhmias (more than I thought), and I get 4 week home halter "patch" starting tomorrow to fully identify arythmias so they can be ablated. Thanks Gemita and AgentX your support is always appreciated, sometimes it is nice just to have people hear you when the doctors keep ignoring you.  I am sure y'all know what I mean.

Thanks for the update

by Gemita - 2020-09-22 04:17:00

Asully, you haven't long to wait for a second opinion.  You have clearly reached a dead end with your current doctor who seems unwilling to explain things to you.  In any event if you have risk factors for an "arrhythmia" related stroke, even without signs of clot formation, you will still need to be assessed for the need for an anticoagulant.  Good luck.

Hope you find the Kardia helpful - I am still thinking about buying the 6 lead one myself, although I am very much in touch with my arrhythmias and I can usually tell from my symptoms alone which one is happening at any given time.  You will soon. be an expert with the Kardia.  Remember to do a few ECG prints from your Kardia Mobile when you are symptomatic, to take with you to your appointment with the new doctor.  That will help him to understand what is going on and make him treat you with respect

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