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Intracardiac thrombi and systemic embolization
Insights
Echocardiography aids in diagnosing intracardiac thrombi. Anticoagulants reduce thrombi and emboli in myocardial infarction and dilated cardiomyopathy, but not typically in left ventricular aneurysm.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Intracardiac thrombi are diagnosed and their natural history traced using echocardiography.
- Left ventricular thrombi are associated with acute myocardial infarction, left ventricular aneurysm, and idiopathic dilated cardiomyopathy, leading to emboli.
Purpose of the Study:
- To review the role of echocardiography in diagnosing left ventricular thrombi.
- To assess the efficacy of anticoagulation in preventing emboli in different clinical conditions.
Main Methods:
- Echocardiographic studies were reviewed.
- Clinical outcomes related to left ventricular thrombi and anticoagulation were analyzed.
Main Results:
- One-third of patients with acute anterior myocardial infarction have left ventricular thrombi; anticoagulation decreases thrombi and emboli.
- Protruding and mobile thrombi are more likely to embolize.
- Anticoagulation is recommended for idiopathic dilated cardiomyopathy, irrespective of thrombus location.
- Anticoagulation is not sufficiently indicated for chronic left ventricular aneurysm, despite common thrombus presence.
Conclusions:
- Echocardiography is crucial for identifying intracardiac thrombi and guiding treatment.
- Anticoagulation is beneficial in acute myocardial infarction and idiopathic dilated cardiomyopathy.
- The role of anticoagulation in left ventricular aneurysm requires further investigation.
Abstract:
Recent progress has been made in diagnosing and tracing the natural history of intracardiac thrombi by echocardiography. Left ventricular thrombi occur and cause emboli in three clinical conditions: acute myocardial infarction, left ventricular aneurysm as a sequel to infarction, and idiopathic dilated cardiomyopathy. Echocardiographic studies have shown that one third of patients with acute anterior myocardial infarction have left ventricular thrombi; only a small percentage of these patients have emboli. Administration of anticoagulants decreases the prevalence of left ventricular thrombi and the frequency of embolization in this group. Thrombi that are protruding and mobile are most likely to embolize. Anticoagulation treatment decreases the prevalence of embolization in idiopathic dilated cardiomyopathy and should be instituted regardless of whether atrial or ventricular thrombi are detected by two-dimensional echocardiography. In patients with chronic left ventricular aneurysm, thrombi occur commonly, but emboli, infrequently. Therefore, data are insufficient to suggest that anticoagulation treatment is indicated, even if left ventricular thrombi are detected by two-dimensional echocardiography.