Case presentation
A 48-year-old Asian male with history of ischemic cardiomyopathy with
low Ejection fraction (EF 15%). Received thrombolysis 2 months ago due
to Right middle cerebral artery stroke. Presented with low cardiac
output state require vasopressors support. patient was receiving
anti-platelet medication (aspirin) but no anticoagulation. On repeating
ECHO, there is excess intra-cardiac smoke-like Echoes fig (1-2). In the
context of old stroke and excess intra-cardiac Smoke -like Echoes the
Soft indication for therapeutic anticoagulation turned to Strong
indication.