Thrombus In Left Ventricle Research Articles

Myocardial infarction complicated by left ventricle thrombus: vitamin K antagonists as first-line treatment?

The article presents the case of a 59-year-old patient hospitalized due to myocardial infarction with ST-segment elevation, who developed a thrombus in the apex of the left ventricle in the early post-infarction period.

Meta-Analysis of Direct Oral Anticoagulants Compared With Vitamin K Antagonist for Left Ventricle Thrombus

BackgroundThe use of direct oral anticoagulants (DOAC) in preference to vitamin K antagonists (VKA) as a treatment of left ventricle (LV) thrombus is controversial. MethodsLiterature search for full-text articles and conference abstracts was performed using PubMed, EMBASE databases search was performed to identify articles that compared use of DOAC vs. VKA in patients with LV thrombus. The primary outcome was composite failure or adverse effects of DOAC and VKA. Other outcomes were resolution of thrombus, systemic thromboembolism, major bleeding, and mortality. Pooled odds ratio (OR) with 95% confidence interval (CI) were computed using random effects model. ResultsSeven studies with 1003 patients (mean age DOAC = 58.8 years and VKA = 58.9 year, 55.5% males) were included in this study. There were 306 (30.5%) patients that were treated with DOAC and 697 (69.5%) patients were treated with VKA. Overall, there were no significant differences between both agents in terms of composite failure/adverse effects, resolution of thrombus, systemic embolism, major bleeding, or mortality. ConclusionIn this pooled analysis, outcomes in patients on DOAC were comparable to VKA. The hypothesis generated could suggest DOAC could be used interchangeably with VKA in patients with LV thrombus. Randomized trials are needed for generalization of results.

Eosinophilic myocarditis: Is endomyocardial biopsy essential for diagnosis in the era of advanced cardiac imaging?

A 60-year-old female presented with dyspnea and chest pressure. Clinical presentation, laboratory data, echocardiography, and cardiac magnetic resonance (CMR) imaging findings confirmed diagnosis of eosinophilic myocarditis and obviated unnecessary invasive endomyocardial biopsy. She was treated with oral steroid and oral anticoagulation. Follow-up CMR imaging showed resolution of the left ventricle thrombus with improvement in endomyocardial inflammation.

THIS TOO SHALL PASS (UNTIL IT DOESN'T): A RARE CASE OF TAKOTSUBO CARDIOMYOPATHY WITH PERSISTENT LEFT VENTRICULAR DYSFUNCTION

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Takotsubo cardiomyopathy (TCM) is characterized by acute regional dysfunction of the left ventricle (LV) triggered by emotional or physical stress. There is an absence of angiographic evidence of obstructive coronary artery disease or acute plaque rupture. TCM is usually reversible within a few weeks to months. Here, we present a rare case of TCM in which 6 months post inciting event there was not only a lack in recovery of LV function, but also new onset ventricular arrhythmias requiring AICD placement. CASE PRESENTATION: A 72-year-old male with a past medical history of hypertension, hyperlipidemia, and diabetes, presented with substernal chest pain for the last 10 days. The patient also reported increased work-related stress recently. EKG showed diffuse ST segment elevations and T wave inversions. Transthoracic echocardiogram (TTE) demonstrated a severely hypokinetic LV apical segment with a left ventricular ejection fraction (LVEF) of 45%. There was no significant atherosclerotic occlusion on coronary angiography. On follow up visit 4 months later, EKG showed persistent diffuse Q waves in anteroseptal and inferior leads with resolution of T wave inversions. The patient also developed new-onset paroxysmal atrial fibrillation. 6 months later, the patient presented with a complaint of palpitations, dizziness, and lethargy. TTE at that time showed persistent diminished LVEF to 45% with continued LV apical hypokinesis. The patient underwent an electrophysiology study that showed new-onset inducible ventricular tachycardia and lengthy sinus nodal reentrant tachycardia. He underwent successful left subclavian dual-lead AICD placement, with resolution of symptoms. DISCUSSION: TCM is generally characterized as transient LV dysfunction secondary to a stressor, with regression of wall motion abnormalities and gradual restoration of LVEF until complete recovery is achieved. Here, we describe a unique case, in which more than 6 months after the inciting event, LV function was still impaired. In approximately 20% of cases of TCM, complications may occur, including cardiogenic shock, heart failure, rhythm disorders, LV thrombus formation, free wall rupture, and death. There have been very few cases, as in this case, in which not only did LV function not recover but rhythm disorders developed months after the inciting event. Differences in the evolution of TCM may be attributed to the different pathophysiological mechanisms that have been cited to contribute to the disorder – namely, catecholamine-induced myocardial stunning, transient epicardial vasospasm, coronary microvascular dysfunction, and transient LV obstructions. CONCLUSIONS: TCM is often characterized as transient LV dysfunction. This case demonstrated the need for close monitoring post inciting event, as there is a possibility for persistent LVEF depression, as well as further complications that could significantly increase mortality. Reference #1: Virani, S. S., Khan, A. N., Mendoza, C. E., Ferreira, A. C., & de Marchena, E. (2007). Takotsubo cardiomyopathy, or broken-heart syndrome. Texas Heart Institute journal, 34(1), 76-9. Reference #2: Zalewska-Adamiec, M., Bachorzewska-Gajewska, H., Tomaszuk-Kazberuk, A., Nowak, K., Drozdowski, P., Bychowski, J., Krynicki, R., Musial, W. J., … Dobrzycki, S. (2016). Takotsubo cardiomyopathy: serious early complications and two-year mortality - a 101 case study. Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 24(9), 511-9. DISCLOSURES: no disclosure on file for Rakesh Gupta; No relevant relationships by Christina Jee Ah Rhee, source=Web Response No relevant relationships by Sharmila Sarkar, source=Web Response

Clinical Characteristics of Patients with a Right Ventricular Thrombus in Arrhythmogenic Right Ventricular Cardiomyopathy.

Thrombus formation within the left ventricle (LV) is a well-known clinical entity and is often associated with underlying myocardial disease, whereas right ventricular (RV) thrombi are rarely observed. This study aimed to investigate the clinical characteristics of patients with arrhythmogenic RV cardiomyopathy (ARVC) who developed an RV thrombus. This study included patients with an RV thrombus from the ARVC databases of the University Heart Center in Zurich, Switzerland, and the Fuwai Hospital in Beijing, China. In total, there were 13 ARVC patients who had an RV thrombus detected. The mean age was 33 ± 15 (range: 11-51) years. Eight patients (62%) were male. The mean Task Force score was 6 ± 1. Nine of these patients (69%) had an RV thrombus only whereas four patients had biventricular thrombi. All 13 ARVC patients had a severely impaired RV function (RV fractional area change 16 ± 9% and RV ejection fraction 15 ± 4%); LV ejection fraction (LVEF) was 40 ± 15%. ARVC patients with an additional LV thrombus had a lower LVEF than the others (24 ± 11 vs. 47 ± 11, p = 0.02). Under therapeutic anticoagulation, complete thrombus resolution was observed in 9/13 patients (69%). RV thrombus formation is a potential complication of ARVC with impaired RV function. In patients with biventricular involvement, thrombi may also occur within the LV. Anticoagulation is generally effective to dissolve RV thrombi. This study highlights the need for awareness during cardiac imaging to detect this rare complication of ARVC.

Heart-brain interactions

Heart-brain interactions are represented by the association of cerebral ischemia with coronary artery disease, cardioembolic cerebral ischemia, and cardiovascular complications due to brain damage. As atherosclerosis is a systemic inflammatory disease, in patients with transient ischemic attack, stroke or asymptomatic carotid artery disease, a previous myocardial infarction, angina or an asymptomatic coronary artery disease are often associated and a correlation between the carotid atherosclerosis and coronary artery disease severity has been reported. Furthermore, the long-term prognosis of patients with stroke is strongly affected by coronary events. At the same time, the prevalence of concomitant cerebrovascular disease is common in patients with coronary artery disease. Other cardiovascular diseases, including left atrial and left atrial appendage thrombosis in atrial fibrillation, thrombi in the left ventricle in acute and chronic coronary artery disease and dilated cardiomyopathies, infective endocarditis with vegetations, cardiac valve prosthesis thrombosis, cardiac tumors, mitral and aortic valve calcifications, aortic plaques and patent foramen ovale, are associated with cardioembolic events. Finally, acute ischemic or hemorrhagic cerebral events, epileptic seizures, cerebral traumas, and brain tumors can be associated with electrocardiographic abnormalities, catecholaminergic myocardial damage, or arrhythmias.

Heart Involvement in Systemic Lupus Erythematosus

Pericardial effusion is considered as one of criteria to diagnose systemic lupus erythematosus (SLE) based on American Rheumatism Association (ARA) criteria. There is limited data about the incidence and characteristic pericardial effusion in SLE patients in our country. The aim of this study is to report and assess the incidence of and characteristic heart involvement in SLE. This is cross-sectional study conducted in secondary referral hospital in Tangerang county, west part of Jakarta, capital city of Indonesia. We evaluated from medical record and echocardiogram data from 2013-2015 patients diagnosed with SLE according to ARA criteria. From 33 SLE medical records reviewed, we found 13 patients (40%) with pericardial effusions. All patients were in active stage. Clinical assessment and transthoracic echocardiogram were used to diagnose pericardial effusions. Eighty percent pericardial effusion positive patients had minimal effusion. The others had moderate effusion. No tamponade patients were recorded. Ninety six percent patients were female with median age 24(13-51) years old. Three patients were reported having pulmonary arterial hypertension. One patient had thrombus in left ventricle. All patients had clinical symptoms of cardiac such as heart failure and chest pain. For the conclusion, the incidence of pericardial effusion in SLE patient was 40 percent. Eighty percent patients had minimal effusion. All patients had cardiac symptoms related.

Obesity, laparoscopic surgery, fluid therapy, solutions

Prognosis in acute Q-wave myocardial infarction is an actual problem till nowadays.Aim: to determine the different regimens of anticoagulation therapy impact on hospital and one-year mortality, acute postinfarction aneurysm and left ventricle thrombus formation in patients with acute Q-wave myocardial infarction after thrombolytic therapy.Materials and methods: hospital and one-year mortality, risk of postinfarction aneurysm and left ventricle thrombus formation were investigated in 167 patients with acute Q-wave myocardial infarction after thrombolytic period depending on anticoagulation therapy. Probability of unfavorable cardiovascular events was assessed by the relative risk with a confidence interval of 95 %. The multiple method of Kaplan-Meier estimation was used to determine the survival distributions. In order to compare survival in different groups the Log-rank test was used. For all types of analyses differences were significant if P < 0.05.Results. It was found that survival during the hospital period was significantly higher in the group of patients received unfractionated heparin compared to patients received fondaparinux. Treatment with unfractionated heparin in comparison with fondaparinux, reliably reduces the relative risk of death during the hospital period. There were no significant differences in the one-year survival of patients who received fondaparinux, enoxaparin, and unfractionated heparin. Thus, all three approaches were equally effective for the long-term prognosis in patients with Q-wave myocardial infarction.There were no significant differences when comparing the relative risk of aneurysm formation and left ventricular aneurysm with a thrombus in the groups of patients with Q-wave myocardial infarction and different anticoagulation therapy. Thus, aneurysm of the left ventricle and left ventricular aneurysm with a thrombus occurred with the same frequency in patients with Q-wave myocardial infarction who were treated with low-molecular or unfractionated heparin.Conclusions. The usage of unfractionated heparin in patients with acute Q-wave myocardial infarction after thrombolytic therapy significantly reduces the risk of hospital mortality by 1.46 times compared with low-molecular-weight heparin. As for one-year mortality, the risk of acute aneurysm and left ventricular aneurysm with a thrombus, the unfractionated and low-molecular-weight heparin were equally effective.

Non-vitamin K antagonist oral anticoagulants for the treatment of intracardiac thrombosis.

Intracardiac thrombus most commonly develops in the left atrial appendage (LAA) and left ventricle (LV) in the setting of atrial fibrillation (AF) and post-myocardial fibrillation (MI), respectively. Current guidelines recommend that patients with post-MI LV or LAA thrombus should be treated with vitamin K antagonist (VKA). However, the use of VKA may be limited by bleeding complications, interactions with various food and drugs, and a narrow therapeutic window requiring frequent monitoring. Thus, non-VKA oral anticoagulants (NOACs) have been attempted as an off-label use for the treatment of intracardiac thrombosis in light of their favorable pharmacologic profile. Until now, therapeutic effect of NOACs on intracardiac thrombosis has not been formally studied in large randomized controlled trials. This article aims to systematically review the literature regarding efficacy and safety outcome of NOACs in the management of intracardiac thrombus. Considering the high rate of complete thrombus resolution and low rate of thromboembolic or hemorrhagic complications, preliminary evidence from case series and reports indicate that NOACs (including factor Xa inhibitors and direct thrombin inhibitors) may be a safe and effective therapeutic option for intracardiac thrombosis, particularly in cases resistant to VKA therapy.

A huge thrombus in left ventricle in a patient with Duchenne type muscular dystrophy；report of a case

A huge thrombus in left ventricle in a patient with Duchenne type muscular dystrophy；report of a case

Takotsubo Cardiomyopathy With a Rapidly Resolved Left Ventricular Thrombus.

This article presents the case of a 53-year-old man who presented with acute right superficial femoral and popliteal arterial thrombosis for which he underwent an emergent uncomplicated thrombectomy. He denied preceding cardiovascular or neurologic symptomatology and had no history of coronary or peripheral arterial disease, trauma, hypercoagulability, or malignancy. However, he reported having several days of intense emotional stress prior to presentation. His cardiac exam was normal, his electrocardiogram showed normal sinus rhythm and nonspecific ST-T wave abnormalities, and his troponin levels were normal. Transthoracic echocardiography (TTE) revealed a large (2.4 × 2 cm) apical left ventricle (LV) thrombus, LV apical akinesis, and LV ejection fraction of 40% to 45%. Coronary angiography revealed only luminal irregularities. A repeat TTE performed 3 days after initiating unfractionated heparin revealed complete resolution of the LV thrombus. The patient had an uneventful clinical course and was discharged home in stable condition on oral anticoagulants. The lower incidence of LV thrombus in takotsubo cardiomyopathy (TC) of 1.3% in comparison to 4% to 8% in acute myocardial infarction due to coronary artery disease in the current era of early reperfusion may be explained by the lower extent of ischemic myocardial necrosis associated with TC. This case suggests that the lower extent of myocardial necrosis in TC may also lead to faster resolution of LV thrombus. Therefore, earlier follow-up with TTE (within 2 weeks) and shorter duration of anticoagulation (<3 months) may be considered in patients with TC complicated by LV thrombus formation with or without systemic embolism.

Outcomes and Prognostic Impact of Prophylactic Oral Anticoagulation in Anterior ST-Segment Elevation Myocardial Infarction Patients With Left Ventricular Dysfunction.

BackgroundThe contemporary role of prophylactic anticoagulation following extensive anterior wall ST‐segment myocardial infarction (STEMI) is unclear.Methods and ResultsWe evaluated anterior STEMI patients with left ventricle dysfunction (left ventricular ejection fraction ≤40%) (“high risk”), categorized by prophylactic warfarin use, within a regional STEMI. Patients with pre‐existing atrial fibrillation were excluded. The primary outcome was an adjusted (for Global Registry of Acute Coronary Events risk score) 1‐year composite of recurrent ischemia, stroke/transient ischemic attack/systemic embolism, or all‐cause death. Of the 2032 STEMI admissions, 436 (21.5%) were high risk. After excluding 19 (4.4%) patients with definite left ventricle thrombus and 21 (4.8%) in‐hospital deaths (2 had left ventricle thrombus), prophylactic warfarin was utilized in 236/398 (59.3%) high‐risk survivors. Prescriptions were comparable across sex, but recipients were on average younger (58.5 years versus 64.0 years, P<0.001) and lower risk (Global Registry of Acute Coronary Events risk: 163 versus 181, P<0.001). No association on the adjusted ischemic composite (23.3% versus 25.3%, odds ratio 0.96, 95% CI 0.60–1.55) or thromboembolic events (2.1% versus 1.2%, odds ratio 1.99, 95% CI 0.38–10.51) was observed, but reduced 1‐year all‐cause mortality was noted (2.5% versus 8.6%, odds ratio 0.30, 95% CI 0.11–0.81); numerically higher major bleeding was observed at 1 year (2.5% versus 1.2%, odds ratio 2.17, 95% CI 0.43–10.96).ConclusionsA high utilization of prophylactic warfarin occurs in anterior STEMI patients with left ventricle dysfunction, yet appears to provide no additional benefit on the ischemic composite. The association with lower all‐cause mortality, but higher bleeding, calls for an improved understanding of its role in high‐risk STEMI.

ROLE OF ANTICOAGULATION THERAPY AFTER ANTERIOR WALL ST-ELEVATION MYOCARDIAL INFRACTION IN PREVENTING LV THROMBUS: A META-ANALYSIS AND META-REGRESSION

Background: Anticoagulation (AC) is used for treatment of left ventricle thrombus (LVT) after anterior wall ST-elevation myocardial infarction (STEMI). Whether AC should be used for prevention in this setting is debated. Our objective was to evaluate the efficacy and safety of AC therapy compared

Intracardiac Mass: A Rare Case Report

Intracardiac thrombus is seen in many circumstances. Rarely it is found in left atrium in the absence of mitral stenosis. Here we are reporting a case of Cardiomyopathy with thrombus in left ventricle and left atrium.

Hemangioma of the left ventricle (RCD code: VI-1B.4)

Cardiac tumors are quite rare, and differential diagnosis of them is challenging. We present the case report of a young man complaining on non specific chest pain who was reported to Cardiology Ward due to suspicion of thrombus in left ventricle. The patient's echocardiography showed an additional mobile structure located in apex of left ventricle. For further investigation he had a cardiac Magnetic Resonance Imaging (MRI) performed which drew out the suspicion of rather unmalignant tumor. Ultimately patient underwent noncomplicated cardiac surgery with total excision of the tumor. Histopatology examination reveald capillary hemangioma.

A Case of Peripartum Cardiomyopathy Affected by Left Ventricle Thrombus

Peripartum cardiomyopathy (PPCM) mimicking dilated cardiomyopathy is defined as an idiopathic cardiomyopathy affecting perinatal or postnatal women with no cardiac history. It occurs in 1 in 20,000 births in Japan. A 25-year-old female without cardiology diseases presented to our hospital’s emergency department with upper abdominal pain, exertional dyspnea, and leg edema. One month prior, she gave birth to her first child via vaginal delivery. At 36 weeks of gestation, she was diagnosed with pregnancy hypertension by an obstetrician. Ultrasonography and non-contrast computed tomography were performed and revealed an edematous gallbladder as well as dilated hepatic and inferior jugular veins. Chest X-ray revealed cardiomegaly, lung edema, and pleural effusion. She was diagnosed with congestive heart failure. Transthoracic echocardiogram (TTE) revealed a dilated left ventricle with a reduced ejection fraction (EF) of 17%. Immediately after admission, diuretic agents, including furosemide and carperitide, were administered. Although her heart failure improved with sufficient diuretic treatment, thromboses measuring 16 × 8 and 29 × 11 mm in her left ventricle were revealed by TTE on day 10. Heparin sodium and warfarin potassium were initiated, which reduced the thromboses. Her symptoms improved, although EF was not restored to normal function. She was discharged on day 40 and an outpatient clinic follow-up was scheduled. Long-term prognosis of PPCM is currently unknown, and meticulous follow-up of the patient is required. Here we present a case of PPCM that was affected by a left ventricular thrombus. J Med Cases. 2016;7(12):550-553 doi: https://doi.org/10.14740/jmc2698w

Eosinophilic cardiomyopathy with thrombus in left ventricle: is there a place for new oral anticoagulants?

Eosinophilic cardiomyopathy with thrombus in left ventricle: is there a place for new oral anticoagulants?

The E-wave propagation index (EPI): A novel echocardiographic parameter for prediction of left ventricular thrombus. Derivation from computational fluid dynamic modeling and validation on human subjects

BackgroundTo describe the derivation and validation of a novel echocardiographic metric for prediction of left ventricle thrombus (LVT). MethodsComputational fluid dynamic modeling using cardiac CT images was used to derive a novel echocardiography-based metric to predict the presence of LVT. We retrospectively reviewed 25 transthoracic echocardiograms showing definite LVT (LVT group). We then randomly selected 25 patients with LVEF ≥55% (Normal EF group) and 25 patients with severe cardiomyopathy (CMP) with LVEF ≤40% without evidence of LVT (CMP group). The E-wave Propagation Index (EPI) was measured as the E-wave velocity time-integral divided by the LV length. An EPI>1 indicates penetration of the mitral jet into the apex whereas an EPI<1 is indicative of incomplete apical washout. The mean EPI was compared between the three groups. Crude and adjusted odd ratios of EPI and LVT association were also measured. ResultsMean EPI was highest for the normal EF group and lowest in the LVT group (1.7 vs. 0.8; p<0.0001). Mean EPI also differed significantly between LVT and CMP groups (0.8 vs. 1.2; p<0.0001). 88% of the LVT group had EPI <1.0 compared to only 20% of the CMP group (p<0.0001). Among the LVT and CMP groups, an EPI <1 increased the odd ratio of LVT by 53.7 times (95% CI: 6.9–416) controlling for LVEF and LV volume. ConclusionsThe E-wave propagation index is a novel, easily-obtainable, echocardiographic metric to evaluate apical LV flow. An EPI of less than 1 is an independent predictor of LVT formation.

141 Eclampsia as the first presentation of peripartum cardiomyopathy

Introduction In some cases eclampsia (which is the main cause of mortality during pregnancy) may be associated with peripartum cardiomyopathy (the main cause of serious complications during pregnancy and postpartum period). Case report Female patient 36 years old, in the 30th week of gestational (the first pregnancy), previously completely healthy, was admitted to hospital due to syncope, convulsion and hypertension (160/100 mmHg). The caesarean delivery was performed immidiately. ECG and echocardiography were without pathological findings, but because of elevated troponin I (0,19) and NT pro BNP (1500), CT coronary angiography was performed. The finding on coronary arteries was completely normal. After improvement in clinical symptoms, values of blood pressure and laboratory findings, patient was discharged. Three months later (in the meantime she didn’t come on the routine clinical folow-up) she was again admitted to hospital due to dyspnoea, peripheral edema and palpitations. Symptoms had begun ten days before that. Physical examination indicated systolic murmur at the apex, signs of left and right heart failure. Laboratory analysis showed leukocytosis, anemia, increased liver ensymes AST (62), LDH (531), uric acid (548), CRP (7,5) and significant increase of NT pro BNP (20975). Electrocardiogram pointed to tachycardia and T-wave inversion in standard and precordial leads. Chest X-ray demonstrated enlarged heart shadow without pathological changes in the lungs. The patient underwent an echocardiography exam which showed dilated left ventricle, global hypokinetic, with low ejection fraction (25%) and with large thrombus in the apex, with very high embolic potential. It also demonstrated moderate mitral regurgitation. The patient was treated according to guidelines on acute and chronic heart failure with ACE inhibitors, beta blockers, diuretics, mineralocorticoid receptor antagonists, also with anticoagulant therapy and supstitution therapy of folic acid and iron, with addition of bromocriptine. Two months later she was symptomless, while echocardiography showed improvement in ejection fraction (45–50%), reduction of mitral regurgitation and completely resolution of the left ventricle thrombus. Finally, about twelve months later, coming to a complete clinical, laboratory, ECG and echocardiography restitution. Conclusion In case of presentation of eclampsia it is necessary to follow up the patient frequently not to miss the beginning of sytolic disfunction due to peripartum cardiomyopathy, which may be coused by eclampsia. It is also important to be aware that some cases need more time (not only six months) for complete restitution.

Thromboembolism in patients with Myocarditis

Background: Myocarditis and dilated Cardiomyopathy continues to be an important cause of hospital admission in our part of the world. Systemic embolism due to thrombi in left ventricle is a rare but important complication of these patients. Study objectives: To determine the incidence, course and outcome of thrombo-embolism in children with dilated dysfunctioning heart due to acute myocarditis or dilated Cardiomyopathy. Design: A 5 year analysis (December 1999- Nov 04) of all children under 16 years of age admitted and diagnosed as having myocarditis or dilated Cardiomyopathy in a single tertiary care center. Patients and Methods: The charts and echocardiography records of all patients with dilated dysfunctioning heart and systemic thrombo-embolism were reviewed. Data was reviewed for mode of presentation, age, hospital course and outcome. Echocardiography data was reviewed with special reference to the size, function and presence of thrombus in LV. Results: Of all admissions to the paediatric cardiology unit over the study period, myocarditis and dilated Cardiomyopathy was the underlying lesion in 405 patients. The mean age of patients was 2.1 4 years. Systemic embolism was the presenting feature in 28 (6.9%) patients (Group A); while another 17 (4.2%) developed it during the hospital stay (Group B). Another 5 patients had thrombus in the LV but did not develop embolism. All 50 patients showed seriously impaired LV function with mean ejection fraction (EF) for those with vs. those without thrombo-embolism was 17.5 5.5 vs. 20.0 6.9 (p = 0.08). The groups were similar with respect to other baseline characteristics, co morbid illnesses, and drug therapies other than anticoagulants. In group A 26/28 patients presented with a stroke. Only 6 had a thrombus in LV at the time of admission. All 28 patients with or without LV thrombus were treated with heparin and then oral anticoagulant warfarin. There were two deaths. In group B, 3/17 patients had thrombus in the LV on echocardiography at presentation. They were started anticoagulation but still went on to develop a stroke. There were 2 deaths in this group as well. Conclusions: Myocarditis and dilated Cardiomyopathy is an important cause of hospital admission in our set up accounting for 15% of all admissions to a paediatric cardiology unit. These patients are at risk of developing thromboembolism, which may well be the presenting feature. The risk is higher in patients with lower ejection fraction of the LV. All patients with EF below 17% should be treated with prophylactic anticoagulation. A peripheral embolic event adds to morbidity and is related to poor long-term survival in this patient group.