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Chronic aneurysmatic dilatation: a possible source of lethal embolization in patients with acute myocardial
P Bellone1, S Domenicucci, F Chiarella
1Cardiology Division, Ente Ospedaliero Ospedali Galliera, Genoa, Italy.
Insights
Acute myocardial infarction can cause left ventricular thrombi, posing an embolization risk. Thrombolytic therapy, while effective for lysis, may paradoxically increase embolization risk by fragmenting existing thrombi.
Area of Science:
- Cardiology
- Vascular Medicine
- Thrombosis Research
Background:
- Left ventricular thrombosis (LVT) is a frequent complication of acute myocardial infarction (AMI), particularly anterior AMI.
- LVT poses a significant risk of systemic embolization, leading to potentially fatal outcomes.
- Antithrombotic therapies are investigated for LVT resolution and embolic risk reduction.
Abstract:
Left ventricular thrombosis is relatively common after acute myocardial infarction, especially in the anterior site, and represents a possible cause of potentially lethal peripheral embolization 1. Therefore, several studies have been performed in order to assess the efficacy of different antithrombotic drugs in resolving the detected thrombi or reducing their embolic potential. Fibrinolytic agents appear effective in this regard: in the majority of cases, they produce complete lysis and resolution of the thrombi. However, this treatment may itself cause embolic complications by producing a rapid fragmentation of thrombus and the subsequent emission of disrupted portions of the intracardiac mass into the systemic vascular bed [2]. This dramatic effect of thrombolysis has suggested the possibility that even the standard treatment of acute myocardial infarction with fibrinolysis implies a danger of embolization in those patients in whom a left ventricular thrombus may be present either from a previous myocardial infarction or from a very early thrombus development. However, this hypothesis has not yet been confirmed by direct observation. We report the case of a patient with a first acute anterior myocardial infarction, in whom the thrombolytic treatment induced lysis and embolization from a left ventricular thrombus present in an aneurysmatic dilatation of the infero-posterior wall due to a previous inferior myocardial infarction.