International Journal of Cardiology 186 (2015) 125
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Right ventricular mural thrombus formation superimposed on previous anterior myocardial infarction Oscar M.P. Jolobe ⁎ MRCP(UK), Manchester Medical Society, Simon Building, Brunswick Street, Manchester M13 9PL, United Kingdom
a r t i c l e
i n f o
Article history: Received 13 February 2015 Accepted 17 March 2015 Available online 18 March 2015 Keywords: Right Ventricular Mural Thrombus Myocardial Infarction
In the event that PE might have occurred as a complication of right ventricular thrombus formation, PE-related dyspnoea might be indistinguishable from dyspnoea attributable to left ventricular failure, given the fact that dyspnoea attributable to PE is misdiagnosed as heart failure in as many as 31% of cases [3]. This degree of misdiagnosis is, arguably, attributable to the fact that orthopnoea can occur in as many as 38% of PE patients who have no prior cardiopulmonary disease [4]. Accordingly, there should be a heightened index of suspicion for PE when right ventricular thrombus formation is superimposed on previous anterior myocardial infarction.
Conflict of interest I have no conflict of interest. In the differential diagnosis of the occurrence of right ventricular mural thrombosis after apparent resolution of an episode of anterior myocardial infarction [1], there should be a high index of suspicion for the occurrence of new-onset silent inferior myocardial infarction as the underlying cause of new onset right ventricular thrombus formation [2], and an equally high index of suspicion that right ventricular thrombus formation might, in turn, be complicated by the occurrence of pulmonary embolism (PE) [2]. The superimposition of the burden of inferior myocardial infarction on the pre-existing burden of anterior myocardial infarction would account for the reported deterioration in left ventricular systolic function, with resulting symptomatic congestive heart failure [1].
⁎ 1 Philip Godlee Lodge, 842 Wilmslow Road, Manchester M20 2DS, United Kingdom. E-mail address: [email protected].
http://dx.doi.org/10.1016/j.ijcard.2015.03.205 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
References [1] F. Wei, W. Fangang, H. Jiangli, L. Zhaoping, G. Lijun, G. Wei, Recurrent intraventricular thrombus following myocardial infarction, Int. J. Cardiol. 181 (2015) 315–316. [2] D.J. Ahdout, P.M. Damani, L.B. Ultan, Recurrent acute pulmonary emboli in association with acute myocardial infarction, Chest 96 (1989) 682–684. [3] J.L. Alonso-Martinez, F.J.A. Sanchez, M.A.U. Echezarreta, Delay and misdiagnosis in sub-massive and non-massive pulmonary embolism, Eur. J. Intern. Med. 21 (2010) 2780282. [4] P.D. Stein, A. Beemath, F. Matta, J.G. Weg, R.D. Yusen, C.A. Hales, et al., Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II, Am. J. Med. 120 (2007) 871–879.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Right ventricular mural thrombus formation superimposed on previous anterior myocardial infarction Oscar M.P. Jolobe ⁎ MRCP(UK), Manchester Medical Society, Simon Building, Brunswick Street, Manchester M13 9PL, United Kingdom
a r t i c l e
i n f o
Article history: Received 13 February 2015 Accepted 17 March 2015 Available online 18 March 2015 Keywords: Right Ventricular Mural Thrombus Myocardial Infarction
In the event that PE might have occurred as a complication of right ventricular thrombus formation, PE-related dyspnoea might be indistinguishable from dyspnoea attributable to left ventricular failure, given the fact that dyspnoea attributable to PE is misdiagnosed as heart failure in as many as 31% of cases [3]. This degree of misdiagnosis is, arguably, attributable to the fact that orthopnoea can occur in as many as 38% of PE patients who have no prior cardiopulmonary disease [4]. Accordingly, there should be a heightened index of suspicion for PE when right ventricular thrombus formation is superimposed on previous anterior myocardial infarction.
Conflict of interest I have no conflict of interest. In the differential diagnosis of the occurrence of right ventricular mural thrombosis after apparent resolution of an episode of anterior myocardial infarction [1], there should be a high index of suspicion for the occurrence of new-onset silent inferior myocardial infarction as the underlying cause of new onset right ventricular thrombus formation [2], and an equally high index of suspicion that right ventricular thrombus formation might, in turn, be complicated by the occurrence of pulmonary embolism (PE) [2]. The superimposition of the burden of inferior myocardial infarction on the pre-existing burden of anterior myocardial infarction would account for the reported deterioration in left ventricular systolic function, with resulting symptomatic congestive heart failure [1].
⁎ 1 Philip Godlee Lodge, 842 Wilmslow Road, Manchester M20 2DS, United Kingdom. E-mail address: [email protected].
http://dx.doi.org/10.1016/j.ijcard.2015.03.205 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
References [1] F. Wei, W. Fangang, H. Jiangli, L. Zhaoping, G. Lijun, G. Wei, Recurrent intraventricular thrombus following myocardial infarction, Int. J. Cardiol. 181 (2015) 315–316. [2] D.J. Ahdout, P.M. Damani, L.B. Ultan, Recurrent acute pulmonary emboli in association with acute myocardial infarction, Chest 96 (1989) 682–684. [3] J.L. Alonso-Martinez, F.J.A. Sanchez, M.A.U. Echezarreta, Delay and misdiagnosis in sub-massive and non-massive pulmonary embolism, Eur. J. Intern. Med. 21 (2010) 2780282. [4] P.D. Stein, A. Beemath, F. Matta, J.G. Weg, R.D. Yusen, C.A. Hales, et al., Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II, Am. J. Med. 120 (2007) 871–879.
