Left ventricular thrombus

Abstract

Left ventricular thrombus (LVT) is a frequent complication in patients with acute anterior myocardial infarction (MI) and in those with dilated cardiomyopathy (DCM). The clinical importance of LVT lies in its potential to embolize. The current treatment of patients with acute MI centers on reperfusion, and although controversial, the incidence of LVT complicating acute anterior MI is probably reduced when compared with historical controls. Nevertheless, stroke continues to be a clinically important complication of acute MI and is most common in patients with anterior MI, in part secondary to embolization of LVT. Therapeutic anticoagulation during acute MI reduces the incidence of LVT, and long-term anticoagulation has been associated with a reduction in recurrent infarction and ischemic stroke, but carries hemorrhagic risk. Primary treatment strategies for patients with acute MI center on reperfusion therapy followed by antiplatelet agents and pharmacologic blockade of abnormal neurohumoral mechanisms. Strategies to prevent stroke following infarction include risk stratification for development of LVT and embolism. For patients with anterior MI, particularly those with apical akinesis or dyskinesis, therapeutic anticoagulation reduces the number of LVT and cardioembolic strokes. However, the absolute number of ischemic strokes prevented with this strategy may only be marginal, given the anticoagulation risk, particularly if antiplatelet agents are used concurrently. An attractive alternative strategy is echocardiographic evaluation following anterior infarction with therapeutic anticoagulation reserved for those with demonstrable thrombus. The efficacy of this strategy, however, never has been proven in a clinical study. Primary prevention of cardioembolic stroke through therapeutic anticoagulation is controversial in patients with DCM; the greatest benefit would be expected for those with severe left ventricular dysfunction. If LVT is detected during the course of MI or DCM, therapeutic anticoagulation is usually indicated with the expectation that the majority of thrombi will resolve without clinical evidence of systemic embolism. Additional therapeutic intervention is rarely needed.

A Rare Case Report of A Pulseless Male Patient With Sequale of Takayasu’s Arteritis.

“…Common causes of cardiac embolization include atrial fibrillation, ischemic heart disease, rheumatic heart disease and prosthetic cardiac valves 3,4,5,6 . Left ventricular thrombi (a frequent complication of transmural acute myocardial infarction, likely to be the case in our patient) 7,8 , are second to atrial thrombi from atrial fibrillation as a cause of cardiogenic embolization. These are easily detectable by two-dimensional echocardiography, although false-positive studies exist 9 .Protruding configuration and free mobility of the thrombus and the presence of adjacent hypokinesia indicate a high embolization potential 10,11 .…”

Presentation, management and outcomes of thrombosis for children with cardiomyopathy

“…While several imaging techniques have been used for its detection (18)(19)(20)(21)(22)(23)(24)(25), two-dimensional echocardiography has been shown to be a sensitive (92%), specific (88%), practical and noninvasive bedside tool (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) to detect and delineate thrombosis in adults and children with cardiomyopathies (7-9). Diagnostic features described in adults (27), which have been applied and confirmed in children (8), include location of the thrombus most frequently in the ventricular apex, the presence of distinct margins with an acoustic density different from the underlying myocardium, free motion of the intracavitary margin of the thrombus, variation in thrombus characteristics noted on serial examinations and abnormal wall motion of the associated myocardial wall segment.…”

“…Initiation of anticoagulation therapy is of unknown value in the presence of intracardiac thrombosis without a thromboembolic event, because the susceptibility of asymptomatic intracardiac thrombosis to embolization is unknown (20,21). Current management algorithms do not distinguish between high-risk subgroups, although there have been attempts to define LV thrombosis characteristics that may be associated with a greater embolic risk in adult patients (20,21,(30)(31)(32). In the absence of such data, there is a trend toward empirical initiation of anticoagulation therapy in the presence of intracardiac thrombosis, especially if the LV shortening fraction is less than 20% (9).…”

Two Serious Complications Observed in Emergency Department in a Cardiovasculopatic Patient

“…One of complication of MI is left ventricular thrombus formation. The CT scan of our patient showed left ventricular apical ballooning with evidence of apical thrombus: in fact, when thrombus cannot clearly demonstrate with echocardiography, a second level exam as a CT is recommended because its higher sensitivity and the optimal therapy of this condition is based on anticoagulant therapy (the patient was under warfarin) [3,4]. At the same time, CT showed perigraft fluid collection with ectopic air and lymphadenopathy.…”