Intracardiac Thrombus

Epidemiology

General Comments
- Left Atrium/Left Atrial Appendage: most atrial thrombi occur in the left atrium/left atrial appendage
- Right Atrium: thrombi rarely occur in the right atrium
  - When present, they are usually associated with venous thrombus that is extending into the RA from either the inferior vena cava (IVC) or superior vena cava (SVC)
  - Right atrial thombus has been reported in the setting of end-stage liver disease (undergoing orthotopic liver transplantation)
Atrial Fibrillation (see Atrial Fibrillation, [[Atrial Fibrillation]])
Intracardiac Devices
- Pacemaker Leads
- Other Devices
Mitral Stenosis (see Mitral Stenosis, [[Mitral Stenosis]])
Mitral Valve Replacement
Venous Thromboembolism
- Deep Venous Thrombosis (DVT) (see Deep Venous Thrombosis, [[Deep Venous Thrombosis]])

General Comments
- Left Ventricle: left ventricular thrombi usually develop in the left ventricular apex
- Right Ventricle: thrombi rarely occur in the right ventricle
  - When present, they are usually associated with venous thrombus that is extending into the RA from either the inferior vena cava (IVC) or superior vena cava (SVC)
  - Right ventricular thombus has been reported in the setting of end-stage liver disease (undergoing orthotopic liver transplantation)
Acute Myocardial Infarction (see Coronary Artery Disease, [[Coronary Artery Disease]]): due to hypokinesis/akinesis of a given wall
Amyloidosis (see Amyloidosis, [[Amyloidosis]])
Behcet’s Disease (see Behcet’s Disease, [[Behcets Disease]])
Chagas’ Disease (see Chagas’ Disease, [[Chagas Disease]])
Dilated Cardiomyopathy/Systolic Congestive Heart Failure (CHF) (see Congestive Heart Failure, [[Congestive Heart Failure]])
Left Ventricular Aneurysm (see Left Ventricular Aneurysm, [[Left Ventricular Aneurysm]])
Renal Cell Cancer (see Renal Cancer, [[Renal Cancer]]): high risk of intracardiac thrombus when renal cell cancer extends beyond the kidney
Intracardiac Devices
- Pacemaker Leads
- Other Devices
Venous Thromboembolism
- Deep Venous Thrombosis (DVT) (see Deep Venous Thrombosis, [[Deep Venous Thrombosis]])

Mechanisms of Intracardiac Thrombus
- Slowed Intracardiac Blood Flow and Aggregation of Thrombotic Material De Novo within Heart
- Formation of Thrombus on Intracardiac Devices
- Formation of Thrombus Elsewhere in the Body with Detection within the Heart While in Transit

Spontaneous echocardiographic contrast (“smoke” appearance) is considered a prethrombotic condition and is associated with an increased risk of thromboembolic events [MEDLINE]
Trans-Thoracic Echocardiogram: sensitivity: 90%/specificity: 85%
- Trans-thoracic echocardiogram is considered to have higher sensitivity than trans-esophageal echocardiogram for the detection of left ventricular thrombi, as trans-esophageal echocardiogram incompletely visualizes the apex: the accuracy of trans-thoracic echocardiogram is further increased by using color Doppler and/or intravenous contrast (Definity)
- Trans-thoracic echocardiogram is considered to have lower sensitivity than trans-esophageal echocardiogram for the detection of left atrial/left atrial appendage thrombi
Transesophageal Echocardiogram: may be used in some cases
Echocardiographic Features Which Predict an Increased Risk of Embolization
- Larger Thrombus Size
- Thrombi Which are Mobile and Protrude into the LV Chamber: particularly in older patients

Detection of Left Atrial Appendage Thrombi
- Sensitivity: 96%
- Specificity: 100%

Acute Mesenteric Ischemia (see Acute Mesenteric Ischemia, [[Acute Mesenteric Ischemia]])

Ischemic Cerebrovascular Accident (CVA) (see Ischemic Cerebrovascular Accident, [[Ischemic Cerebrovascular Accident]])
- Epidemiology: intracardiac thrombi are found in up to 26% of patients with ischemic CVA [MEDLINE]

Risk factors for intracardiac thrombus in patients with ischaemic cerebrovascular events. J. Neurol. Neurosurg. Psychiatry75,1421–1425 (2004) [MEDLINE]