Left ventricular thrombus

A condition involving a blood clot in the left ventricle of the heart

Left ventricular thrombus (LVT) is a medical condition characterized by the formation of a blood clot within the left ventricle of the heart. This condition is often associated with myocardial infarction, cardiomyopathy, and other forms of heart disease.

Pathophysiology

The formation of a left ventricular thrombus is typically a result of abnormal blood flow, endothelial injury, and hypercoagulability, which are collectively known as Virchow's triad. After a myocardial infarction, the damaged heart muscle can lead to areas of akinesis or dyskinesis, creating a turbulent flow that predisposes to thrombus formation. Additionally, the inflammatory response following myocardial injury can further promote a prothrombotic state.

Clinical Presentation

Patients with a left ventricular thrombus may be asymptomatic or present with symptoms related to embolism, such as stroke or peripheral arterial disease. In some cases, patients may experience symptoms of heart failure due to the underlying cardiac condition.

Diagnosis

Ventricular thrombus on echocardiogram

The diagnosis of left ventricular thrombus is primarily made using echocardiography, which can visualize the thrombus within the left ventricle. Cardiac MRI is another imaging modality that can be used to confirm the presence of a thrombus and assess its characteristics.

Management

The management of left ventricular thrombus involves anticoagulation therapy to prevent embolic events. Warfarin is commonly used, although newer direct oral anticoagulants (DOACs) are being studied for this indication. The duration of anticoagulation therapy is typically determined by the underlying cause and the risk of embolism.

Prognosis

The prognosis of patients with left ventricular thrombus depends on the underlying cardiac condition and the risk of embolic complications. Effective anticoagulation can significantly reduce the risk of embolism and improve outcomes.

Prevention

Preventive strategies focus on managing the underlying cardiac conditions that predispose to thrombus formation. This includes optimal medical therapy for myocardial infarction and heart failure, as well as lifestyle modifications to reduce cardiovascular risk factors.

Related pages

• Myocardial infarction
• Cardiomyopathy
• Heart failure
• Anticoagulation