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Smoker, 80 years old, suspected heart failure : Case 3

Contrast Echocardiography for assessment of LV structure and function

Patient Description

  • 80 year old male
  • Smoker
  • Admitted due to suspected Heart Failure November 2007
  • Echo revealed severely decreased systolic LV function, EF 15%
  • Normal angiogram (Non-ischemic dilated cardiomyopathy)
  • Numerous runs of non-sustained VT
  • Scheduled for ICD
  • Medication led to a clinical improvement; NYHA IIIb, II, No remaining VT episodes during mobilisation


Echocardiography 4th Dec to see whether EF improved > 35 %

Siebilink et al. Coron Artery Dis 2009;20:462–466


 

Echocardiography

  • A slight improvement of EF, still ICD indication BUT…
  • A strange thickening of the apical myocardium
  • SonoVue bolus was given for clarity…
  • Apical layer of mural thrombus which is not perfused in contrast to the clear myocardial perfusion seen using low MI imaging (MI 0.1)

 

  • 991 post MI pts
  • 156 LV contrast due to suspected LV thrombust

 

Contrast Echo Box : Atlas

 Contrast Echo Box : Atlas      

Contrast Echo Box : Atlas

Note: Apical thrombus cannot be reliably diagnosed without contrast in many cases