Asked for Male | 49 Years
Can my heart's function improve after LV clot treatment?
Patient's Query
Primary PCI to LAD performed on 03 August 2025 Urgent PTCA to LAD done Patient developed ventricular tachycardia (VT) → DC cardioversion performed Became hemodynamically stable Discharged on 11 August 2025 in improved condition Echocardiography Progression 11 Aug 2025 (Discharge): EF ≈ 52% 26 Sep 2025: EF 42% Big apical LV clot RWMA present 07 Nov 2025: EF 40% Small LV clot 26 Dec 2025 (Latest): EF 32% Large apical LV clot RWMA Mild mitral regurgitation Mild aortic regurgitation Current Medications Rivaroxaban (XCEPT) 20 mg once daily (evening) Aspirin (Loprin) 75 mg once daily Ticagrelor (Tissara) 90 mg twice daily Nebivolol (Bywas) 2.5 mg once daily Sacubitril/Valsartan (Sucavia) 50 mg – half tablet twice daily High-intensity statin ✔ Medication compliance: 100% (no missed doses) Key Concerns Gradual decline in EF (52% → 32%) Persistent LV apical thrombus with variable size reporting Need to assess whether clot is chronic/stable or active Prognosis and potential for EF recovery Appropriateness of Rivaroxaban vs Warfarin for LV clot Purpose of Consultation Seeking expert opinion on: Management of persistent LV apical thrombus Optimization of heart failure therapy Likelihood of EF improvement
Answered by Dr. Bhaskar Semitha
It's important to know that after a heart attack and with heart failure, the heart's pumping ability can weaken over time, leading to a decrease in EF. The LV clots could be due to blood pooling in the heart chambers, especially if the heart isn't pumping effectively. To address this, it's crucial to continue your medications diligently, as you've been doing. I would recommend further evaluation with your cardiologist to assess the stability of the clots and discuss the option of transitioning to Warfarin for better management. With ongoing treatment and close monitoring, there is still a good chance for your EF to improve.
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