Left ventricular thrombus in a patient with recurrent ischemic stroke events-The role of echocardiography.

Key Clinical Message: Cardiac ultrasound is recommended in investigating ischemic stroke events. There is increasing evidence that direct oral anticoagulants can be safely used instead of vitamin K antagonists in the setting of left ventricular thrombus. Abstract: Cardioembolic stroke is responsible for an increasing number of ischemic strokes. Compared to other causes of stroke, cardioembolic strokes affect a larger brain area. Left ventricular (LV) thrombi account for up to 10% of cardioembolic strokes. It is essential to identify patients at high risk of LV thrombus formation, such as patients with a history of myocardial infarction, patients with reduced ejection fraction, or patients with cardiomyopathies. We present a patient with an ischemic stroke, and the cardiac ultrasound revealed a reduced ejection fraction and the presence of LV thrombus at the apex. The patient had no prior history of cardiovascular diseases. Even in a resource-limited setting, cardiac ultrasound is recommended to investigate stroke or transient ischemic attack events, especially in patients with a prior history of myocardial infarction. Although patients with LV thrombus should be treated with oral anticoagulants for at least 3 months, the role of direct oral anticoagulants and the optimal period of anticoagulation in this setting needs further investigation.

Atrial fibrillation and Wolff-Parkinson-White syndrome: A double blow for the cardiologist.

Electrocardiographic findings including irregularity of the rhythm, a very rapid ventricular response, and the presence of a delta wave should raise the suspicion of pre-excited atrial fibrillation with a rapid ventricular response. Urgent cardioversion is needed due to the risk of sudden cardiac death.