Left ventricular thrombus and early pericardial effusion after anterior STEMI: a case report

Abstract

Introduction: Left ventricular thrombus is an uncommon but clinically important complication of large anterior ST-elevation myocardial infarction (STEMI), associated with an increased risk of systemic embolization. When accompanied by early post-infarction pericardial effusion, therapeutic decision-making becomes particularly challenging because anticoagulation is required in the setting of increased bleeding risk.

Aim: The aim of this article is to present a rare case of concomitant left ventricular thrombus and early pericardial effusion following anterior STEMI and to highlight the associated management challenges.

Patients and Methods: A 52-year-old woman presented with acute anterior STEMI and underwent emergency primary percutaneous coronary intervention. Serial transthoracic echocardiography, clinical evaluation, and laboratory testing were performed to assess left ventricular function, thrombus formation, pericardial effusion, and response to therapy.

Results: Successful reperfusion of the culprit artery was achieved. On the third hospital day, echocardiography revealed an apical left ventricular thrombus and mild early pericardial effusion. Dual antiplatelet therapy, a vitamin K antagonist, and colchicine were initiated. At one-month follow-up, complete thrombus resolution was observed, and at three months, imaging confirmed recovery of regional wall motion and full resolution of the pericardial effusion.

Conclusion: This case illustrates the complexity of balancing embolic and hemorrhagic risks when left ventricular thrombus coexists with pericardial effusion and emphasizes the need for an individualized, imaging-guided therapeutic approach in the absence of definitive guideline recommendations.