Sohaib Minhas, Syed Waleem Pasha
Left ventricular (LV) thrombus is known to occur following acute myocardial infarction (MI), generally seen when there is reduced left ventricular (LV) systolic function, and is an uncommon presentation in patients with preserved ejection fraction. We describe a case of a 28-year-old man with recurrent presentations with central chest pain in the weeks following primary percutaneous coronary intervention for an anterior ST-elevation MI (STEMI). Transthoracic echocardiography (TTE) revealed apical LV thrombi despite preserved systolic function. Coronary angiography confirmed patent left anterior descending artery stents without obstructive coronary artery disease. The patient's age, previous ischaemic stroke secondary to basilar artery thrombus, and absence of obvious significant cardiovascular risk factors raised suspicion for an underlying thrombophilic disorder. A thrombophilia screen was performed and was positive for lupus anticoagulant, suggesting antiphospholipid syndrome. Therapeutic anticoagulation was initiated with low-molecular-weight heparin bridging to warfarin. Follow-up TTE one month later demonstrated persistent LV thrombus, and continued imaging surveillance was arranged. He had follow up with haematology, who elected to keep him on long-term anticoagulation with warfarin. This case highlights that LV thrombus may develop despite preserved LV systolic function following MI and emphasises the importance of considering inherited or acquired thrombophilic conditions in young patients with recurrent thromboembolic events or unexpected LV thrombus. Early recognition of an underlying prothrombotic state may influence long-term anticoagulation strategies and reduce the risk of future embolic phenomena.