PMC2639563_01
Electrocardiogram on admission.
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F1
The admission ECG revealed sinus rhythm, normal QRS axis, a Q-wave at I, aVL and ST-segment elevation at leads I, aVL, V3-V6 with reciprocal ST-segment depression at leads III, aVF (figure 1).
Electrocardiogram ten days later.
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F2
On the following days ST-segment elevations gradually decreased and negative T-waves appeared at the same leads, following the pattern of acute myocardial infarction (figure 2).
A. Apical four chamber view. It depicts a thrombus in the apex (arrows) Abbreviations: LV:left ventricle, RV: right ventricle, LA: left atrium, RA: right atrium, THRO: thrombus. B. The thrombus has disappeared after anticoagulant therapy. Abbreviations: as in figure 3A.
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F3
However, on the third day of hospitalization, a second echocardiogram revealed the presence of a mural thrombus attached to the previously recognized hypokinetic area (figure 3A). Antithrombotic therapy was initiated (with low molecular weight heparin and acenocoumarol) and three days later the thrombus gradually disappeared (figure 3B) without any embolic sequela.
Electrocardiogram one year later.
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F4
Twelve months later, while being on corticosteroids, the patient remains asymptomatic, with a normal ECG (figure 4), and a normal echocardiogram.