Echocardiographic Recognition of Left Ventricular Mural Thrombus

Left ventricular (LV) mural thrombus is a well recognized complication of acute myocardial infarction. In survivors of infarction, its incidence is influenced by the location and magnitude of infarction: it occurs often in patients with large anterior Q wave infarctions, particularly in the presence of LV apical akinesis or dyskinesis. Although radionuclide imaging with indium-111-labeled platelets, computed tomography, and magnetic resonance imaging may be used to identify LV mural thrombus, two-dimensional echocardiography is the technique of choice for assessing its presence, shape, and size, and recent technical advances in echocardiographic methodology, such as high-frequency, short-focal-length transducers, have improved the echocardiographic assessment of LV mural thrombus. In the patient in whom a mural thrombus is identified, acute and chronic anticoagulation (with heparin and warfarin, respectively) is indicated: first, to prevent further thrombus formation and, second, to reduce the incidence of systemic embolization.