{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:40:03Z","timestamp":1756309203505,"version":"3.44.0"},"reference-count":4,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,1,19]]},"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:p>A 54 year-old man was admitted after being found on the floor of his home, thought to have been there for approximately 5 days. He was diagnosed with a non-ST elevation myocardial infarction and bilateral cerebral ischaemic infarcts, as well as an acute kidney injury driven by rhabdomyolysis. The following day, bilateral lower limb ischaemia was observed. A full body CT angiogram revealed a complete thromboembolic shower with bilateral arterial occlusion in the lower limbs, bilateral pulmonary emboli, a splenic infarct and mesenteric ischaemia. An echocardiogram revealed a large thrombus in the left ventricle as the likely thromboembolic source. Bilateral lower limb amputations were recommended, commencing a complex discussion regarding the best course of management for this patient. The discussion was multifaceted, owing to the patient\u2019s lack of capacity, and input from multiple teams and the patient\u2019s relatives was required. Both ethical and clinical challenges arise from this case of a thromboembolic shower.<\/jats:p>","DOI":"10.1136\/bcr-2020-238580","type":"journal-article","created":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T16:26:32Z","timestamp":1612887992000},"page":"e238580","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Multiorgan thromboembolic shower and its ethical implications"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9478-6192","authenticated-orcid":false,"given":"Amedra","family":"Basgaran","sequence":"first","affiliation":[{"name":"Stroke Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sayani","family":"Khara","sequence":"additional","affiliation":[{"name":"Stroke Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aravinth","family":"Sivagnanaratnam","sequence":"additional","affiliation":[{"name":"Stroke Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,2,9]]},"reference":[{"doi-asserted-by":"publisher","key":"2025082708044936000_14.2.e238580.1","DOI":"10.1136\/heartjnl-2012-301962"},{"key":"2025082708044936000_14.2.e238580.2","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1002\/clc.23039","article-title":"Left ventricular thrombosis in acute anterior myocardial infarction: evaluation of hospital mortality, thromboembolism, and bleeding","volume":"41","author":"Ram","year":"2018","journal-title":"Clin Cardiol"},{"unstructured":"NICE . Unstable angina and NSTEMI: early management; Clinical guideline [CG94]. Available: https:\/\/www.nice.org.uk\/guidance\/CG94 [Accessed May 2019].","key":"2025082708044936000_14.2.e238580.3"},{"unstructured":"NICE . Stroke and transient ischaemic attack in over 16s: diagnosis and initial management; NICE guideline [NG128]. Available: https:\/\/www.nice.org.uk\/Guidance\/NG128 [Accessed May 2019].","key":"2025082708044936000_14.2.e238580.4"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-238580","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:04:57Z","timestamp":1756307097000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-238580"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2]]},"references-count":4,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2,9]]},"published-print":{"date-parts":[[2021,2]]}},"alternative-id":["10.1136\/bcr-2020-238580"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-238580","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,2]]}}}