A Rare Case of Left Atrial Free Floating Ball Thrombus Presenting as Acute Coronary Syndrome

Left atrial free-floating thrombus is a rare clinical finding associated with mitral valve disease. Its presentation with acute coronary syndrome is further rare, reported in only a few case reports. A 55-year-old patient had critical mitral stenosis with atrial fibrillation but was not on anticoagulation because of poor follow-up. She presented with acute chest pain. Her electrocardiogram was suggestive of posterior wall ischemia. Echocardiography revealed a large free-floating spherical left atrial thrombus, and coronary angiography showed embolic occlusion of the distal left circumflex artery. The patient was started on anticoagulation and was planned for surgery; however, the patient had a sudden cardiac arrest before surgery. We stress the peculiar and varied presentations of left atrium free-floating thrombus due to the high risk of embolization and high mortality risk associated with them.