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.

Stenting of a stenotic aortic homograft in pulmonary position after the Ross procedure.

Pulmonary autograft replacement of the aortic valve (Ross procedure) has potential advantages, with favorable rates of survival and freedom from reoperation. The procedure itself, however, involves insertion of a homograft in the pulmonary position. The development of severe homograft stenosis is an uncommon but clinically important complication. We report the case of a young female who developed a symptomatic homograft stenosis a year after she underwent the Ross procedure. The lesion was stented successfully and the homograft's patency, together with a markedly improved pressure gradient, was still maintained eight months after percutaneous stenting.

Nonbacterial vegetations in a young patient with primary antiphospholipid syndrome.

The classical clinical picture of the antiphospholipid syndrome (APS) is characterized by venous and/or arterial thromboses, fetal losses and thrombocytopenia, in the presence of antiphospholipid antibodies (aPL). We present the case of a young male patient who suffered a transient ischemic cerebrovascular attack and whose cardiac investigation revealed a cardiac source of embolus, namely non-bacterial vegetations of the mitral valve. Laboratory testing confirmed the diagnosis of primary APS.