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How to recognise an LV thrombus when you see one: a review of cardiac point-of-care ultrasound

© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. CASE PRESENTATION A 47yearold man presents to the ED with shortness of breath and chest pain. The shortness of breath has been progressively worsening in the setting of running out of his medications 3 days prior, while the chest pain started after smoking methamphetamines the day prior to presentation. He denies any fevers, new cough, sputum production or sick contacts. He has a 20year history of daily methamphetamine use. His medical history is notable for heart failure with a reduced ejection fraction (HFrEF) of 20%, type 2 diabetes, coronary artery disease (CAD), untreated deep vein thrombosis and depression. His prescribed medications include furosemide, carvedilol, lisinopril, atorvastatin, metformin and aspirin. On physical examination, the patient has a BP of 118/83 mm Hg, HR of 121, temperature of 36.4°C, RR of 22, and an oxygen saturation of 100% on 11 L with a nonrebreather mask. He is nontoxic appearing, but in clear respiratory distress with tachypnoea and increased work of breathing. His pulmonary examination is notable for crackles at the bases. Cardiac examination is notable for tachycardia without murmurs, rubs or gallops. His abdomen is soft but protuberant. Lower extremities are warm and well perfused with 2+ pitting oedema from the ankle to the midshin, bilaterally. Intravenous access is obtained; blood is obtained and sent for processing. A pointofcare ultrasound (POCUS) is performed.