What is LV apical thrombus?

Left ventricular thrombus is a blood clot (thrombus) in the left ventricle of the heart. LVT is a common complication of acute myocardial infarction (AMI). Typically the clot is a mural thrombus, meaning it is on the wall of the ventricle.

How is LV thrombus treated?

Intravenous thrombolysis has also been used for treatment of documented LV thrombus. In a report of 16 patients with LV thrombus on echocardiography, urokinase was infused intravenously at a rate of 60 000 U/h for 2–8 days in combination with intravenous heparin (200 units/kg×12 h).

What causes an LV thrombus?

A Virchow’s triad of factors – reduced ventricular motion, local myocardial injury and hypercoagulability/stasis of flow contribute to formation of LV thrombus. Reduced ventricular contractility – Blood stagnation in the weak non-contractile segment of the ventricle plays a major role in formation of thrombi.

What is apical Akinesis?

The presence of LV apical akinetic aneurysmatic area was defined as a discrete dyskinetic or akinetic segment of the distal portion of the chamber with a relatively wide communication to the LV cavity detected by left ventriculogram in the absence of significant CAD or prior history of hypertrophic cardiomyopathy.

How is LV thrombus diagnosed?

Standard transthoracic echocardiography (TTE) is typically the screening modality of choice for LV thrombus detection and should be performed within 24 hours of admission in those at high risk for apical LV thrombus (e.g., those with large or anterior MI or those receiving delayed reperfusion).

Can a left ventricular thrombus cause stroke?

Left ventricular thrombus (LVT) is associated with a significant risk of ischemic stroke (IS) and peripheral embolization. Societal guidelines recommend the use of warfarin, with direct oral anticoagulants (DOACs) only for patients unable to tolerate warfarin.

How long do you treat LV thrombus?

LV thrombus can lead to arterial embolic complications such as stroke. Patients with LV thrombus or those at high risk for development of this complication should receive anticoagulation for at least three months.

How long does it take for LV thrombus to resolve?

The LV thrombus size was reduced in 121 (76.1%) cases with total resolution in 99 (62.3%) within a median of 103 days (interquartile range, 32-392 days).

What is Akinesis of heart?

Akinesis, or lack of wall motion, is one serious complication of myocardial infarction that may have a profound effect on cardiac hemodynamics.

What makes up a thrombus?

A thrombus, colloquially called a blood clot, is the final product of the blood coagulation step in hemostasis. There are two components to a thrombus: aggregated platelets and red blood cells that form a plug, and a mesh of cross-linked fibrin protein. The substance making up a thrombus is sometimes called cruor.

What is the relationship between apical akinesia and thrombosis?

Thrombus seems to disappear more often in patients with apical akinesia than those with apical aneurysm or dyskinesia. 1

Is vitamin K antagonist therapy still the standard of care for LV thrombus?

However, at present vitamin K antagonist therapy is still the standard of care for the treatment of LV thrombus. More importantly, the newer anticoagulants also have the risk of fatal and non-fatal bleedings and their role in LV thrombus patients should be further assessed. Antiplatelet therapy and triple therapy in the PCI era

What is the pathophysiology of left ventricular thrombus (LVT)?

Left ventricular thrombus (LVT) can complicate left ventricular (LV) systolic dysfunction both in ischemic and non-ischemic cardiomyopathies and can lead to thromboembolic complications such as stroke.

Is apical thrombus present in LGE cardiac magnetic resonance imaging?

The presence of apical thrombus (arrow) is clearly evident in LGE cardiac magnetic resonance (b) compared to cine-cardiac magnetic resonance (a). Recent evidence highlights that delay of imaging for more than 5 days after acute MI was associated with significantly higher detection rates of LVT compared to imaging within 5 days.