Coronary Artery Disease and Left Ventricular Mural Thrombi: Clinical, Hemodynamic and Angiocardiographic Aspects

Abstract

Twenty-two patients were found, during cardiac catheterization, to have mural thrombi in the left ventricle. Their ages varied from 40 to 72; the majority wen referred for evaluation because of angina peetoris. A history of multiple infarctions was noted in 13 patients. Only eight, however, had electroc~pldc evidence of two previous myocardial infarctions. The clinical and hemodynamic features inclpded cardiomegaly in 12, electrocardiographic evidence of previous anterior wall (anterior or anteroseptal) myocardhl infarction in 21 and the uniform finding of left ventricular dysfunction as well as severe stemis > 95 percent) or complete obstruction of the left anterior descending artery in all 22. The frequency of mural thrombns in the total group of 458 pa tients with arteriosclerotic beart disease evaluated during the period of time of this study was 4.8 percent. If, however, one only considers patients with evidence of previC ardiac mural thrombi are commonly found at postmortem examination.I4 Arteriosclerotic heart disease is the most frequent form of heart disease associated with mural-thrombi of the left ventricle.' It is generally appreciated that mural thrombi in the left ventricle are commonly associated with ventricular aneurysm^.^,^ Pathologic studies, however, have documented the frequent occurrence of mural thrombi with acute and healed transmural myocardial infar~tion.'~,~ Mural thrombi of the heart can be suspected clinically during an acute myocardial infarction complicated by a systemic emb~lus.~-'~ It has been estimated that 1 percent of all acute myocardial infarctions are complicated by such systemic thromboembolic manifestations. Indeed, acute myocardial infarction has presented initially with a thromboembolic complication. All studies on mural thrombi of the heart are based on postmortem studies. The purpose of the present paper is to give the clinical, hemodynamic and angiographic findings in 22 patients who were found, at the time of study, to have mural thrombi of the left ventricle. These patients win be compared to