Left ventricular thrombus: Difference between revisions
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{{CMG}} | {{CMG}} '''Associate Editor in Chief''': {{MUT}} | ||
==Overview== | ==Overview== | ||
Left ventricular thrombus is a complication of systolic [[heart failure]] and [[myocardial infarction]]. [[Thrombus]] develops in the presence of Virchow's triad; blood stagnation due to [[akinesis]]/[[hypokinesis]], [[hypercoagulability]] and [[endocardial]] injury. The thrombus may cause [[strokes]] and systemic thromboembolism. | |||
==Incidence== | |||
Left ventricular thrombus occurs less frequently now, with higher rates of performance of [[primary PCI]] in the treatment of [[ST elevation myocardial infarction]]. The reported incidence is approximately 4-15%. In the absence of revascularization the incidence can be much higher, 20-60%. In [[heart failure]] patients the incidence is approximately 11-40%. The annual risk of thromboembolism in patients with ischemic cardiomyopathy is 1.4-12%. | |||
==Pathophysiology== | |||
Left ventricular thrombus occurs most importantly due to blood stasis around the [[akinetic]] segment in the [[left ventricle]]. Mobile and protruding thrombi carry the highest risk of embolization. | |||
==Diagnosis== | |||
[[Echocardiography]] is the most common modality used to identify left ventricular thrombus. A transthoracic echo has a sensitivity of about 60% which increases with the use of contrast. [[Cardiac MRI]] with [[gadolinium]] contrast is the most sensitive and specific diagnostic test, which makes it the gold standard test. | |||
==Treatment== | |||
[[Anticoagulation]] is the main stay of treatment. AHA/ACC guidelines recommend at least 3 months of warfarin therapy and indefinitely if the bleeding risk is low. | |||
==References== | ==References== | ||
Latest revision as of 12:24, 21 April 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor in Chief: M.Umer Tariq [2]
Overview
Left ventricular thrombus is a complication of systolic heart failure and myocardial infarction. Thrombus develops in the presence of Virchow's triad; blood stagnation due to akinesis/hypokinesis, hypercoagulability and endocardial injury. The thrombus may cause strokes and systemic thromboembolism.
Incidence
Left ventricular thrombus occurs less frequently now, with higher rates of performance of primary PCI in the treatment of ST elevation myocardial infarction. The reported incidence is approximately 4-15%. In the absence of revascularization the incidence can be much higher, 20-60%. In heart failure patients the incidence is approximately 11-40%. The annual risk of thromboembolism in patients with ischemic cardiomyopathy is 1.4-12%.
Pathophysiology
Left ventricular thrombus occurs most importantly due to blood stasis around the akinetic segment in the left ventricle. Mobile and protruding thrombi carry the highest risk of embolization.
Diagnosis
Echocardiography is the most common modality used to identify left ventricular thrombus. A transthoracic echo has a sensitivity of about 60% which increases with the use of contrast. Cardiac MRI with gadolinium contrast is the most sensitive and specific diagnostic test, which makes it the gold standard test.
Treatment
Anticoagulation is the main stay of treatment. AHA/ACC guidelines recommend at least 3 months of warfarin therapy and indefinitely if the bleeding risk is low.