Refractory left ventricular failure: use of two-dimensional echocardiography in identification of thrombi

A 65-year-old woman was hospitalized several times after having an acute anteroseptal transmural infarction. Her course was complicated by recurrent ventricular tachycardia and severe left ventricular failure. Chest x-ray films showed pulmonary congestion and mild right pleural effusion. Two-dimensional echocardiography revealed a large left ventricular thrombus, which resolved after two months of treatment. The course of anticoagulation was later complicated by massive gastrointestinal hemorrhage. Finally, the patient died in her sleep, probably as a result of arrhythmia. An autopsy revealed extensive left ventricular mural thrombi. The early identification of left ventricular thrombus by two-dimensional echocardiography has lifesaving implications. It is possible that, with proper medical management, further formation of pulmonary emboli could be prevented.