Left ventricle thrombus



Left ventricular thrombus (LVT) is a blood clot in the left ventricle of the heart. 



LVT is a common complication  of acute myocardial infarction (AMI).



Typically the clot is on the wall of the ventricle.



The primary risk of LVT is the occurrence of cardiac embolism.



With cardiac embolism the thrombus detaches from the ventricular wall and travels through the circulation and blocks blood vessels. 



LVT occurs in patients with reduced left ventricular systolic function.



LVT  is most common with ischemia, which is observed and up to 80% of patients with LVT.



LVT occurs most often during the first 2 weeks following AMI.



LVT major complication is distal embolization in the form of stroke or systemic embolism.



The risk of LVT formation increases as infarction size increases, resulting in stagnation of ventricular blood.



After myocardial infarction monocytes and macrophages clear cellular debris from the infarct, and in their absence chances of LVT formation are very high. 



The failure to clear cellular debris from the infarct site compromises the endothelial lining of the left ventricle and exposes the damaged tissue to the blood, with the building of a thrombus 


composed of fibrin, red blood cells and platelets.



After a Acute MI the levels of tissue factor and D-dimer are high for a few days, which increases the risk of LVT formation.



LVT diagnosis is achieved mainly by echocardiography.



Computed Tomography and Magnetic Resonance Imaging of the chest are effective, but less common ways to detect LVT.



Echocardiographic studies can determine the mobility and protrusion of the thrombus associated with increased embolic potential.



After an AMI, patients should be treated to prevent LVT formation: Aspirin plus an oral anticoagulant are suggested for individuals at risk for thromboembolic events.



Anticoagulants reduce the risk of embolisms when a thrombus is already formed.



Systemic anticoagulation is the first-line medical therapy for LVT, as it reduces the risk of systemic embolism.



Surgical thrombectomy can also be performed.



Anticoagulation for 3-6 months to decrease the risk of stroke is indicated.



The rate of LVT formation after AMI is declining due to the use of better therapies.



LVT formation after ST elevation MI treated with percutaneous coronary intervention is low, estimated at only 2.7%.



Then incidence of LVT is higher in anterior wall AMI, compared with other types.


Leave a Reply

Your email address will not be published. Required fields are marked *