Left ventricular thrombus: Difference between revisions
No edit summary |
|||
| Line 15: | Line 15: | ||
==Diagnosis== | ==Diagnosis== | ||
Echocardiography is the most common modality used to identify LV thrombus. A transthoracic echo has a sensitivity of about 60% which increases with the use of contrast. | Echocardiography is the most common modality used to identify LV 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. | ||
==References== | ==References== | ||
Revision as of 02:42, 21 April 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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, hyper coagulability and endocardial injury. The thrombus may cause strokes and thromboembolism.
Incidence
Left ventricular thrombus occurs rarely now, with the use of primary PCI in the treatment of ST elevation myocardial infarction. The reported incidence is around 4-15%. In the absence of revascularization the incidence can be much higher, 20-60%. In heart failure patients the incidence is around 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 of the LV. Mobile and protruding thrombi carry the highest risk of embolization.
Diagnosis
Echocardiography is the most common modality used to identify LV 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.