ventricular thrombus found on echo 12 yrs post mi. , 10 yrs post icd #1

[vivor]

On workup for hernia surgery, (echo and stress thallium), intraventricular thrombus was discovered.
  Exercise tolerance was excellent(acheieved target hr of 145 in 12 min at moderate perceived effort, despite 3 mos. inactivity due to hernia). Slight ST elevation noted during test.
ICD #2 (5+ yrs old) is due for replacement soon.

Two primary questions:

1)Is there a question or questions which could be asked to

help verify the diagnosis, or is diagnosis via echocardiogram

fairly straightforward(How often is an echo mis-interpreted)?

2)If dx. is accurate, what are treatment options, and where

would ICD replacement fit in?

(p.s. now 4 days post hernia surgery, recovering well, and back

  on 81mg. aspirin) .


  Thank you very much for considering.

"Sir" Vivor  

[Cleveland Clinic]

vivor,

thanks for the post.

1)Is there a question or questions which could be asked to
help verify the diagnosis, or is diagnosis via echocardiogram
fairly straightforward(How often is an echo mis-interpreted)?

Sometimes the echo can be misleading, but if they are able to obtain good views, and the setting is right, ie..prior heart attack with an area of the heart that doesnt beat well, then the diagnosis can be pretty assured.  MRI, CT or TEE can sometimes help confirm a questionable diagnosis.

2)If dx. is accurate, what are treatment options, and where
would ICD replacement fit in?  (p.s. now 4 days post hernia surgery, recovering well, and back on 81mg. aspirin) .

Usually, if there is LV thrombus, then coumadin therapy should be considered.  As far as the ICD, it shouldnt impact the change after a period of anticoagulation unless an LV lead is going to be placed. If so, an period of anticoagulation should preced lead placement.


good luck