Left ventricular apical thrombus formation in a patient with suspected tako-tsubo-like left ventricular dysfunction

Circ J. 2003 Jun;67(6):556-8. doi: 10.1253/circj.67.556.

Abstract

A 74-year-old woman with hypertension and bronchial asthma had chest discomfort at rest and 4 days later was admitted to her nearby hospital because of the sudden onset of right hemiparesis. The hemiparesis had almost disappeared within 24 h of onset, but because an electrocardiogram showed sinus tachycardia and diffuse symmetrical T-wave inversion, she was referred for cardiac examination. Coronary angiography did not reveal any significant coronary artery stenosis, but left ventriculography revealed severe hypokinesis of the left ventricular apical region, which contained a 4 x 4-mm solid thrombus moving freely with a wavy motion. Moreover, the activity of both protein C and protein S had decreased. The thrombus disappeared after 2 weeks of anticoagulant treatment with warfarin. Her clinical course suggested that the transient cerebral ischemic attack was caused by embolism of the left ventricular thrombus associated with 'tako-tsubo-like left ventricular dysfunction'.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anticoagulants / therapeutic use
  • Female
  • Heart Diseases / etiology*
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / pathology
  • Humans
  • Ischemic Attack, Transient / etiology
  • Radiography
  • Syndrome
  • Thrombosis / etiology*
  • Ventricular Dysfunction, Left / classification
  • Ventricular Dysfunction, Left / complications*
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / physiopathology
  • Warfarin / therapeutic use

Substances

  • Anticoagulants
  • Warfarin