Event Title

Hidden trouble – a clot in an unusual location

Location

Auditorium Pond Side

Start Date

26-2-2014 10:30 AM

Abstract

Background:Aneurysms of the left ventricle may form as a complication of myocardial infarction. Left ventricular aneurysms comprise of fibrosed and thinned out portions of the left ventricle which potentiate blood stasis and thrombus formation. Such aneurysms with mural thrombus are most commonly seen at the left ventricular apex and often result in cardio embolic stroke.

Case History: We present the case of a 55 year old gentleman who was a known diabetic and hypertensive. He had a remote history of acute myocardial infarction. A recent echocardiogram revealed infero-posterior akinesia with basal infero-posterior aneurysm formation. He was admitted with a diagnosis of urosepsis. In hospital, he developed a Non-STEMI for which he was managed medically. The next day he developed new onset left sided hemiparesis. MRI Brain revealed multifocal acute infarcts in both supra and infra tentorial territories. In view of his ongoing fever and imaging features of cardio-embolic stroke, a trans-esophageal echocardiogram was performed. The TEE study initially revealed the same findings as the trans-thoracic study. However on further elaboration on trans-gastric views, a much larger basal inferior segment aneurysm was visualized which was filled with thrombus. Echocardiographic features suggested that the thrombus was non-organised. In view of these previously unrecognized findings, both anti-coagulation and aneurysmectomy were suggested. However, the patient and his family were unwilling for further interventions and the patient was discharged on oral anticoagulation.

Conclusion: This case illustrates the importance of trans-esophageal echocardiogram in the evaluation and management of suspected cardio-embolic stroke.

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Feb 26th, 10:30 AM

Hidden trouble – a clot in an unusual location

Auditorium Pond Side

Background:Aneurysms of the left ventricle may form as a complication of myocardial infarction. Left ventricular aneurysms comprise of fibrosed and thinned out portions of the left ventricle which potentiate blood stasis and thrombus formation. Such aneurysms with mural thrombus are most commonly seen at the left ventricular apex and often result in cardio embolic stroke.

Case History: We present the case of a 55 year old gentleman who was a known diabetic and hypertensive. He had a remote history of acute myocardial infarction. A recent echocardiogram revealed infero-posterior akinesia with basal infero-posterior aneurysm formation. He was admitted with a diagnosis of urosepsis. In hospital, he developed a Non-STEMI for which he was managed medically. The next day he developed new onset left sided hemiparesis. MRI Brain revealed multifocal acute infarcts in both supra and infra tentorial territories. In view of his ongoing fever and imaging features of cardio-embolic stroke, a trans-esophageal echocardiogram was performed. The TEE study initially revealed the same findings as the trans-thoracic study. However on further elaboration on trans-gastric views, a much larger basal inferior segment aneurysm was visualized which was filled with thrombus. Echocardiographic features suggested that the thrombus was non-organised. In view of these previously unrecognized findings, both anti-coagulation and aneurysmectomy were suggested. However, the patient and his family were unwilling for further interventions and the patient was discharged on oral anticoagulation.

Conclusion: This case illustrates the importance of trans-esophageal echocardiogram in the evaluation and management of suspected cardio-embolic stroke.