What is apical thrombus?

For the purpose of this paper our definition of an apical mural thrombus is a distinct mass of echoes, most commonly seen in the apex throughout the cardiac cycle, and in more than one view. Mural thrombi are most commonly seen between six and 10 days following an acute myocardial infarction (MI).

What is right ventricular thrombus?

A thrombus in the right heart in the absence of atrial fibrillation, structural heart disease or catheters in-situ is rare. It usually represents a travelling clot from the venous system to the lung. In view of the reported high mortality, it constitutes a medical emergency and requires immediate treatment.

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.

What causes atrial thrombus?

Causes of arterial thrombosis Arterial thrombosis usually affects people whose arteries are clogged with fatty deposits. This is known as atherosclerosis. These deposits cause the arteries to harden and narrow over time and increase the risk of blood clots.

Where does apical mural thrombus occur in the heart?

They occur at the left ventricular apex and are more common following an anterior wall infarction, since anterior MIs involve more of the apex (fig 2 ). This thrombus usually develops on a dyskinetic or akinetic area or within a left ventricular aneurysm (fig 3 ).

Where is thrombus located in an LV apical aneurysm?

Many, but not all, of these patients will have an LV apical aneurysm with akinesis or dyskinesis. In most cases, thrombus is located within or adjacent to the LV apex [ 1] but can also occur with large inferolateral infarctions/aneurysms.

Which is the apical window of left ventricular thrombus?

As most left ventricular thrombi occur at the cardiac apex, the apical and subxiphiod windows are the most useful. It can also be helpful to obtain multiple views, often unconventional or foreshortened, with the transducer angled slightly to visualise the apex better. As high a frequency probe as possible should be used.

How is the diagnosis of right heart thrombus made?

Two-dimensional echocardiography was diagnostic of right heart thrombus in four patients and showed evidence of right heart dysfunction in those with major pulmonary thromboembolism. The diagnosis was confirmed at surgery in three patients and at autopsy in one.

How is LV thrombus detected?

Transesophageal echocardiography (TEE) is the gold standard technique for detecting thrombus of the left atrium or left atrial appendage although TTE is also widely used for excluding LV thrombus in patients with acute ischemic stroke.

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 apical 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.

Where are mural thrombus found?

Mural thrombi can be seen in large vessels such as the heart and aorta and can restrict blood flow. They are mostly located in the descending aorta, and less commonly, in the aortic arch or the abdominal aorta.

What causes cardiac thrombus?

Coronary artery thrombus occurs due to rupture or erosion of preexisting coronary artery plaque, resulting in the artery’s complete occlusion. [1] It manifests clinically as an acute coronary syndrome, including ST-elevation MI, Non-ST elevation myocardial infarction, and unstable angina[2].

How does myocardial infarction cause thrombosis?

Eventually, plaque rupture can occur, and contact of blood with the exposed subendothelial matrix and plaque content causes the formation of occlusive thrombi. This cascade of events leads to the clinical manifestation of MI with angina pectoris, myocyte death, and ultimately, impaired cardiac function.

What causes left ventricular thrombus?

Left ventricular thrombus is common among patients undergoing echo, with dilated cardiomyopathy being the most common underlying aetiology followed by myocardial infarction. Multiple LVTs were documented in peripartum cardiomyopathy.

What causes an LV thrombus?

Can mural thrombus cause sudden death?

Large thrombus in a vessel can occlude a vessel and can induce ischemia, also termed as mural thrombi, resulting in the death of tissue. Sometimes thrombi are free-floating and can dislodge to the distal vessel. Embolization to the brain can lead to stroke. Embolization to the limb can lead to amputation.

Which is the distal branch of the apical thrombus?

Coronary CT shows the left apical thrombus (green arrow). The distal ‘wrap-around’ LAD is occluded (white arrow), as well as the last diagonal branch (yellow arrow).

What kind of probe to use for apical mural thrombus?

As high a frequency probe as possible should be used. A 5 MHz, short focus probe or even a 7 MHz is ideal. The higher frequency helps in giving better resolution for differentiating between a thrombus and the underlying myocardium.