Severe Heart Failure and Large Left Ventricular Thrombus Following Acute Myocardial Infarction

Case Presentation A 58 year-old man who recently underwent a left superficial femoral artery thrombectomy presented with a three-day history of worsening exertional dyspnea and bilateral pedal edema. His past medical history is significant for coronary artery disease, myocardial infarction, and insulin dependent diabetes mellitus. The patient initially presented to an outside hospital where he developed ventricular tachycardia that warranted cardioversion three times. Initial electrocardiogram showed inferior lead ST segment elevations and lateral lead ST depression. The patient underwent a cardiac catheterization that showed triple vessel disease with total occlusion of the RCA, 90% occlusion of the LAD, and 50% to 60% occlusion of left circumflex. The patient had an echocardiogram (Figures 1 and 2) that showed severe left ventricular dysfunction with an ejection fraction of 10% and a large mobile thrombus occupying 60% of the left ventricular cavity and was diagnosed with a dilated cardiomyopathy. The patient underwent left ventricular thrombectomy (Figure 3), coronary artery bypass graft (i.e., a saphenous vein graft to LAD) and installation of a left ventricular assist device. The patient currently is doing well and is awaiting heart transplantation.