Muhammad Rehan Khan, Habibullah Khan, Muhammad Marwat.
Frequency of left ventricular thrombus in ST elevation myocardial infarction on echocardiography.
Gomal J Med Sci Jan ;11(2):129-32.

Background: Left ventricular (LV) thrombus formation is a well-known complication of ST segment elevation myocardial infarction (MI). In acute MI extensive area of severe apical wall motion abnormality (WMA) with stagnant flow is responsible for thrombus formation. Aim of our study is to determine the frequency of mural left ventricular thrombus in the acute STEMI on echocardiography. Material & Methods: It was a descriptive cross sectional study conducted in Cardiology Department of District Headquarter Teaching Hospital D.I.Khan from October 2012 to April 2013. Total 119 patients with acute STEMI patients were included, while patients with technically difficult windows and with previous MI were excluded from the study. Patients presenting with typical chest pain lasting for more than 30 minutes with typical evolutionary ECG changes of acute STEMI were studied. In addition to Troponin T , rise in CK.MB level were considered as diagnostic of acute MI. Detail history and clinical examination was carried out in each patient. Bedside echocardiography was done on day first, day 3 and day 5 for detection of LV thrombus. Frequency and percentage for categorical variables like gender, LV thrombus and type of MI were presented in the form of tables. Means and SD + was calculated for numeric variable like age. Results: Out of 119 patients 83 (70%) were male and 36 (30%) were female. Thirty (25%) patients were in age group of up to 50 years, 70 (59%) were in age group of 51-75 years and nineteen (16%) were in age group of more than 75 years. The mean age of our patients was 59.5±11.0 years. We performed serial 2-D echocardiography in 119 patients; LV thrombus was found in nine (7.56%) patients; 6 patients were of anterior MI,2 patients with anterolateral MI & 1 patient with anteroinferior MI. Patients with inferior-wall infarction: none had a left-ventricular thrombus.The thrombus was located in the LV apex. The mean LV ejection fraction was 31% (range 20–40%). Out of 119 patients, anterior myocardial infarction patients were 66 (55.46%), inferior myocardial infarction patients were 43 (36.13%) and anterolateral myocardial infarction patients were 6 (5.04%) and anteroinferior MI were 4 (3.36%). Conclusion:LV thrombus is common in patients having anterior wall STEMI. We conclude that patients with severe apical-wall-motion abnormalities during acute anterior MI are at high risk for LV thrombosis. This high-risk group can be identified before the development of LV thrombi. Patients with inferior infarction or anterior infarction without a severe apical WMA are at low risk. Thrombus development is important because it can lead to arterial embolic complications such as stroke. Patients with LV thrombus, or those at high risk, should receive anticoagulation for at least three months.

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