The Effects of Thrombolysis on Left Ventricular Thrombus Formation After First Acute Anterior Myocardial Infarction

Abstract

The Left Ventricular Thrombus (LVT) after Acute Myocardial infarction (AMI) is usually located in the Left Ventricle particularly at the apex and occurs much more frequently (98%) in anterior infarcts and in larger infarcts. Early thrombus formation is associated with worse LV wall motion and caries high long-term mortality, and a poor prognosis. We studied the occurrence of LVT in first episode of Acute Q wave Anterior Myocardial Infarction ¡n patients presenting to Mayo Hospital during hospital stay and evaluated whether thrombolysis had any effects on the LVT formation in such setting. A total of 30 (24 males, 6 females) patients with first episode of anterior wall AMI were included in this study. The mean age of male patients was 51.79 ± 13.86 years, and that of female patients was 54.83±10.15 years. Echocardiographic examination was done 6 days after Presentation. Eight (6 males, 2 females) patients (26.66%) were found to have LVT. At presentation 16 patients (53.33%) were thrombolysed with intravenous Streptokinase infusion, out of which 2(12.5%) developed LVT and 14(87.5%) did not. Among the 14(46.66%) non-thrombolysed patients 6(42.7%) were found to have LVT. It showed a 70.79% reduction in relative risk for LVT in patients with first acute anterior wall MI. Amongst the thrombolysed patients 3(18.74%) developed cardiac failure. Out of those patients who were not thrombolysed (n =14), 8(57.1%) developed cardiac failure. The occurrence of cardiac failure in patients who were not thrombolysed at presentation was statistically significant. At Mayo Hospital, Lahore 26% of patients with first Q wave anterior wall myocardial infarction showed LVT on day 6 when examined echocardiographically. The effect of thrombolysis in reducing the occurrences of LVT is statistically insignificant. The development of cardiac failure after AMI is associated with increased occurrence of LVT and this is seen more in non-thrombolysed patients.