Apical Thrombus Research Articles

Development of biventricular large apical thrombi and cerebral embolism in a young woman with peripartum cardiomyopathy

Peripartum cardiomyopathy is a rare cardiac disorder. Although left ventricular apical thrombus formation is common in peripartum cardiomyopathy, biventricular apical thrombi formation is a very rare condition in these patients. A 21-year-old woman presented with complaints of dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and palpitations that appeared three months after labor. Transthoracic echocardiography showed severe global hypokinesis, decreased left and right ventricular ejection fraction (left 30%, right 35%), increased left ventricular end-diastolic dimension (60 mm), grade 2 mitral regurgitation, and biventricular apical thrombi. On the second day of admission, she developed global aphasia and right hemiplegia. The patient was successfully treated with recombinant tissue plasminogen activator. Transthoracic echocardiography following treatment showed disappearance of biventricular apical thrombi. She had no neurologic deficit. Treatment for heart failure was continued due to persistence of global hypokinesis and left ventricular dilatation.

406 Clinical utility of transthoracic echocardiography in patients with atrial fibrillation undergoing evaluation for suspected stroke

406 Clinical utility of transthoracic echocardiography in patients with atrial fibrillation undergoing evaluation for suspected stroke

Detection of Left Ventricular Apical Thrombus With Three-Dimensional Transesophageal Echocardiography

OBJECTIVE. Left ventricular (LV) thrombosis persists as a clinical challenge in echocardiographic diagnosis and is an important risk factor for perioperative embolic events in cardiac surgery. Appropriate detection and monitoring when thrombus is suspected is critical in surgical planning and in avoiding catastrophic patient outcomes. CASE PRESENTATION. The authors present a case of a laminated LV apical thrombus, which was discovered intraoperatively by real-time 3-dimensional (3D) transesophageal echocardiography. CLINICAL CHALLENGES. The clinical challenges were (a) LV thrombosis impact on surgical management, (b) key echocardiographic challenges in diagnosing LV thrombosis, and (c) role of 3D echocardiography in the diagnostic algorithm. CONCLUSION. Because of the lack of a gold standard, 2D transthoracic echocardiography remains the imaging modality of choice in assessment; however, there is increasing evidence that 3D technology can be more accurate in intracardiac mass detection and should be considered in the diagnostic algorithm.

Recurrent takotsubo cardiomyopathy in the setting of transient neurological symptoms: a case report

IntroductionFirst described in Japan, takotsubo cardiomyopathy is increasingly becoming recognized worldwide as a cause of sudden and reversible diminished left ventricular function characterized by left apical ballooning and hyperkinesis of the basal segments, often with symptoms mimicking a myocardial infarction. Associated with physical or emotional stress, its exact pathogenesis has not been established, though evidence supports a neurohumoral etiology. Additionally, recurrence of this condition is rare. In this report, we present a rare case of recurrent takotsubo cardiomyopathy in a post-menopausal woman who presented with transient neurological complaints on both occasions.Case presentationWe present a rare case of a 76-year-old Caucasian woman with no history of congestive heart failure who presented to our emergency department twice with transient neurological complaints. On the first occasion, she was found to have transient aphasia which resolved within 24 hours, yet during that period she also developed symptoms of congestive heart failure and was noted to have a new, significantly depressed ejection fraction with apical akinesis and possible apical thrombus. One month after her presentation a repeat echocardiogram revealed complete resolution of all wall motion abnormalities and a return to baseline status. Seven months later she presented with ataxia, was diagnosed with vertebrobasilar insufficiency, and again developed symptoms and echocardiography findings similar to those of her first presentation. Once again, at her one-month follow-up examination, all wall motion abnormalities had completely resolved and her ejection fraction had returned to normal.ConclusionThough the exact etiology of takotsubo cardiomyopathy is unclear, a neurohumoral mechanism has been proposed. Recurrence of this disorder is rare, though it has been reported in patients with structural brain abnormalities. This report is the first to describe recurrent takotsubo cardiomyopathy in a patient with transient neurological symptoms. In our patient, as expected in patients with this condition, complete resolution of all left ventricular abnormalities occurred within a short period of time. It is important for clinicians to be aware of this increasingly recognized syndrome, including its association with recurrence, especially in the clinical setting of neurologic dysfunction.

Hypereosinophilic Syndrome Presenting with Large Left Ventricular Apical Thrombus and Pulmonary Embolism

A 45-year-old man presented with dyspnea on exertion, fatigue, and cough. Transthoracic echocardiography showed a large apical thrombus in the left ventricle. The laboratory results showed prominent eosinophilia on blood smear, elevated acute phase reactants and D-dimer serum levels. Bone marrow examination showed a Fip1-like platelet-derived growth factor receptor alfa fusion gene mutation. The case was diagnosed as myeloproliferative variant hypereosinophilic syndrome. Contrast-enhanced computed tomography demonstrated thrombi not only in left ventricle but also in multiple segmental pulmonary arteries. Cardiac magnetic resonance imaging showed left ventricular apical thrombus without subendocardial fibrosis. Cardiopulmonary manifestations of hypereosinophilic syndrome completely resolved after treatment.

Hypertrophic Cardiomyopathy With Left Ventricular Apical Aneurysm in Brothers

The investigators report similar phenotypes of hypertrophic cardiomyopathy with left ventricular apical aneurysm and thrombus in 2 brothers aged 8 years apart. This report highlights the genetic predisposition for this unique, high-risk phenotype, the issue of prophylactic anticoagulation, and the importance of nonstandard echocardiographic imaging views in the assessment of these patients.

An undulating giant left ventricular apical thrombus after myocardial infarction

A 54-year-old patient with a history of anterior myocardial infarction one year previously was admitted to the cardiology department. Electrocardiography showed sinus rhythm and persistent ST–segment elevation in the precordial leads indicating ventricular aneurysm. Transthoracic echocardiography revealed left ventricle apical aneurysm and a giant undulating thrombus (77 × 63 mm) in it (Fig. 1, video). The left ventricular ejection fraction was calculated as 15%. Anticoagulation treatment was started immediately and he was monitored closely. Fig. 1 Transthoracic echocardiography apical for chamber view frame showing left ventricular dilatation (LV), apical aneurysm and a giant apical thrombus (T). RV: right ventricle The differential diagnosis of abnormal cardiac masses includes primary or secondary heart tumours, thrombus, infectious structures such as vegetation, abscess or hydatid cyst. Most commonly encountered masses in the left ventricle are thrombus, fibroma and metastatic cancers [1]. Fibroma is well demarcated from the surrounding myocardium by multiple calcifications and as with other neoplasms, does not associate with akinetic or dyskinetic ventricular segments. The patient had no history of malignancy and there was no sign of infection on admission. Nevertheless, echocardiographic examinations during hospitalisation for acute myocardial infarction and during a clinical visit, five months ago, had not revealed any left ventricular mass. So, the most probable diagnosis was a giant left ventricular thrombus in the large apical aneurysm. Left ventricular thrombus is usually associated with coronary artery disease and myocardial infarction [2] or any other situations associated with wall-motion abnormalities as cardiomyopathy, myocarditis, and takotsubo cardiomyopathy. Rarely hypercoagulable or inflammatory states may predispose for left ventricular thrombus formation [3, 4]. The major concern for LV thrombus is the potential for thromboembolism causing morbidity and mortality. There are many case reports comparing left ventricular thrombus dimensions [5], but this is the biggest left ventricular thrombus reported to literature, to the best of our knowledge.

Thrombose coronaire distale compliquant une leucémie aiguë lymphoblastique traitée par asparaginase

A 53-year-old man is treated by l-asparaginase for an acute lymphoblastic leukaemia. He received anti thrombin infusions. A systematic electrocardiogram showed an asymptomatic subepicardium ischemia without troponin elevation. Echocardiography and heart magnetic resonance imaging showed an apical thrombus facing a zone of myocardial necrosis. A thrombus regression was observed under anticoagulation. Atypical and asymptomatic coronary thrombosis may occur following l-asparaginase treatment. Regular electrocardiogram monitoring is proposed along this treatment. Arterial thrombosis associated with anti tumor chemotherapies are reviewed.

Myocardial Infarction With Intracardiac Thrombosis as the Presentation of Acute Promyelocytic Leukemia

A 29-year-old woman presented in February 2010 with acute-onset severe chest pain. This radiated to the left shoulder and was associated with breathlessness. She was afebrile, her saturations were 100% on air, and her clinical examination was entirely normal. An electrocardiogram showed diffuse 2- to 3-mm ST-segment elevation. At presentation, troponin I was elevated at 2.4 ng/mL (normal <0.1 ng/mL). Full blood count, chest radiograph, arterial blood gas, and bedside echocardiogram were unremarkable. She was diagnosed with myopericarditis and discharged from the accident and emergency department with nonsteroidal anti-inflammatories. Two days later, she returned with worsening chest pain and was admitted for investigation. She had a full blood count, and urea and electrolytes were within the normal range. Troponin I was significantly elevated at 15.2 ng/mL, C-reactive protein was >160 mg/L (normal 20 000 μg/L (normal 0 to 500 μg/L). Her electrocardiogram showed further widespread ST elevation, and repeat bedside echocardiogram demonstrated a mass at the left ventricular apex, with apical hypokinesis (Figure 1 and online-only Data Supplement Movie I). A cardiac magnetic resonance scan revealed apical scarring consistent with a small myocardial infarct, with adherent apical thrombus in both the left and right ventricles (Figures 2 and 3 and online-only Data Supplement Movies II and III). Figure 1. A, Electrocardiogram showing diffuse ST-segment elevation. B, Transthoracic echocardiogram: apical 4-chamber view in systole showing …

Left ventricular apical thrombus formed in a case with preserved left ventricular systolic function

Left ventricular apical thrombus formed in a case with preserved left ventricular systolic function

Takotsubo Cardiomyopathy: A Case of Persistent Apical Ballooning Complicated by an Apical Mural Thrombus

Takotsubo cardiomyopathy (TTC) is an infrequent cardiac syndrome characterized by acute onset chest pain with apical ballooning on echocardiography. It is often triggered by severe emotional or physical stress, and in contrast to acute myocardial infarction (AMI), the regional wall motion abnormality returns to normal within days. Here, we describe a 62-year-old female who presented with acute onset chest pain during treatment for a liver abscess. We presumed a diagnosis of AMI because of ST segment elevation on electrocardiography and elevated cardiac enzyme levels. However, the patient's coronary arteries were normal on angiography, and apical ballooning was seen on echocardiography. A diagnosis of TTC was made, and the patient was managed with intensive cardiopulmonary support using vasopressors in our hospital's medical intensive care unit. The patient's symptoms improved, but persistent severe left ventricular dysfunction was detected on follow-up echocardiography. After 5 weeks, a new apical mural thrombus appeared, and anticoagulation therapy was started. The apical ballooning persisted 3 months later, although the patient's overall ejection fraction was slightly improved. The apical thrombus was completely resolved without any embolic event. Non-adrenergic inotropics can be recommended in TTC with shock, and clinicians should keep in mind the potential risk of thrombus formation and cardioembolism.

Isolated Noncompaction of Ventricular Myocardium: a Magnetic Resonance Imaging Study of 11 Patients

ObjectiveTo retrospectively summarize the cardiac magnetic resonance imaging (CMRI) findings of isolated noncompaction of ventricular myocardium (INVM).Materials and MethodsEleven patients (M:F = 9:2; mean age, 35 years) were evaluated. Steady-state free precession (SSFP), fast spin echo (SE) sequence, SSFP cine imaging, and delayed enhanced inversion recovery spoiled gradient echo (IR-SPGR) sequence were used for showing abnormal myocardium, measuring ratio of noncompacted/compacted myocardium layers (NC/C ratio), and detecting myocardial viability. The left ventricle was divided into nine segments and a NC/C ratio > 2.3 in diastole was used as cutoff value in diagnosing left INVM. The right ventricle was assessed qualitatively.ResultsCardiac MRI indicated left INVM in seven patients, right INVM in one patient and biventricle INVM in three patients. Characteristic CMRI changes included prominent trabeculations, deep intertrabecular recesses and an increase in the NC/C ratio. The most frequently involved segments was left ventricular apex. Three patients had abnormal high signals within the trabecular structures on SE T2 weighted image. One ventricular aneurysm and one apical thrombus were also observed. Delayed enhancement was seen in six of nine patients with subendocardial and transmural patterns.ConclusionThere are CMRI features that might be characteristic for INVM.

Stress-Induced Cardiomyopathy: The Role of Echocardiography

Echocardiography is widely used to carry out non-invasive cardiac evaluation at the bedside and provides useful real-time information about hemodynamics. It can also be used to diagnose a stress-induced cardiomyopathy and its complications such as shock, heart failure and apical thrombus. Early diagnosis and management are important to prevent possible complications, and short-term follow-up by echocardiography can readily determine the improvement in these abnormalities. In this brief review, we summarize the role of echocardiography in stress-induced cardiomyopathy, with a special focus on its benefits in the era of new emerging diagnostic technology.

Two Cases of Cerebral Embolism Caused by Apical Thrombi in Midventricular Obstructive Cardiomyopathy

Midventricular obstructive hypertrophic cardiomyopathy (MOHC) is a rare form of cardiomyopathy that was demonstrated to have caused embolic stroke in two patients. In both cases, the embolic sources of stroke were thrombi in an apical aneurysm caused by turbulent stasis of blood flow and subsequent injury of myocardial endocardium. Even without atrial fibrillation, apical aneurysm can induce emboligenic stroke in MOHC.

Apical hypertrophic cardiomyopathy

We describe a patient with asymptomatic apical hypertrophic cardiomyopathy (AHCM) who later developed cardiac arrhythmias, and briefly discuss the diagnostic modalities, differential diagnosis and treatment option for this condition. AHCM is a rare form of hypertrophic cardiomyopathy which classically involves the apex of the left ventricle. AHCM can be an incidental finding, or patients may present with chest pain, palpitations, dyspnea, syncope, atrial fibrillation, myocardial infarction, embolic events, ventricular fibrillation and congestive heart failure. AHCM is frequently sporadic, but autosomal dominant inheritance has been reported in few families. The most frequent and classic electrocardiogram findings are giant negative T-waves in the precordial leads which are found in the majority of the patients followed by left ventricular (LV) hypertrophy. A transthoracic echocardiogram is the initial diagnostic tool in the evaluation of AHCM and shows hypertrophy of the LV apex. AHCM may mimic other conditions such as LV apical cardiac tumors, LV apical thrombus, isolated ventricular non-compaction, endomyocardial fibrosis and coronary artery disease. Other modalities, including left ventriculography, multislice spiral computed tomography, and cardiac magnetic resonance imagings are also valuable tools and are frequently used to differentiate AHCH from other conditions. Medications used to treat symptomatic patients with AHCM include verapamil, beta-blockers and antiarrhythmic agents such as amiodarone and procainamide. An implantable cardioverter defibrillator is recommended for high risk patients.

Hypereosinophilic syndrome presenting as cardiac mass : a rare case report

Summary Background: Hypereosinophilic syndrome is a rare systemic disease characterized by idiopathic eosinophilia with multiple organ involvement. Symptoms vary in accordance with which organ is affected. Cardiac involvement is one of the most serious complications, substantially contributing to the morbidity and mortality of patients with hypereosinophilic syndrome. Case Report: We present a rare case of hypereosinophilic syndrome with cardiac mass in a 30-year-old male due to a thrombus in the left ventricle. After being treated with intravenous corticosteroid and antico-agulant his symptoms improved, and treatment was tapered with Prednisolone and Warfarin. A sig-ni cant reduction in the size of the clot was shown by echocardiography and 5 months later there was no evidence of a residual clot. Conclusions: This is a case report characteristic with apical thrombus of hypereosinophilia of the heart. Echocardiography is recommended for follow-up of hypereosinophilic syndrome patients with car-diac involvement.

A case of tako-tsubo cardiomyopathy with apical thrombus formation

A case of tako-tsubo cardiomyopathy with apical thrombus formation

Hypertrophic Cardiomyopathy Complicated by Large Apical Aneurysm and Thrombus, Presenting as Ventricular Tachycardia

Coronary angiography showed normal vessels. He was treated with beta-blockade and warfarin, but declined an implantable cardioverter-defibrillator.Apical aneurysms are present in up to 2% of patients with hypertrophic HCM (1), althoughthe exact cause, natural history, and optimal therapies are not well defined. This case demon-strates multiple complications of nonobstructive HCM.

E0430 Highsensitivity Creactive protein levels at admission can not be used to predict inhospital mortality in patients with acute myocardial infarction a retrospective study

ObjectiveTo investigate the possible influencing factors of serum high-sensitivity C-reactive protein (hs-CRP) levels on admission, and to assess the the association between admission serum hs-CRP levels and mortality in patients...

Left ventricular apical aneurysm due to unrecognized sarcoidosis.

A 47-year-old woman was hospitalized for syncope. An electrocardiogram showed complete right bundle branch block and T-wave inversion in leads III, aVF, and V2-4. Cardiac catheterization was performed since the echocardiogram demonstrated the existence of a left ventricular apical aneurysm and apical thrombus. Coronary angiography revealed normal coronary arteries. An endomyocardial biopsied specimen from the right ventricular apical wall demonstrated typical noncaseating granulomas with giant cells. There was no evidence suggesting the involvement of other systemic organs. The patient was diagnosed as having cardiac sarcoidosis. Cardiac sarcoidosis should be considered within a spectrum of diseases that cause left ventricular apical aneurysm.