CONGRESS ABSTRACT

We describe the case of a 75-years-old patient, admitted to our Emergency Department for sudden-onset aphasia and left hyposthenia. His clinical history included arterial hypertension, hypercholesterolemia, chronic coronary syndrome due to a previous myocardial infarction with residual moderate left ventricular dysfunction (EF 40%) and aneurysm of the inferior left ventricular wall. At the arrival, the head Computed Tomography (CT) angiography confirmed an ischemic stroke caused by thrombosis of the right median cerebral artery. Fibrinolysis was performed within the terapeutic time window. Unfortunately, the patient developed a ventricular tachycardia with hemodynamical instability, needing immediate electrical cardioversion and amiodarone infusion. The following transthoracic echocardiography (ETT) showed a large thrombus inside the patient’s ventricular aneurysm, with a partially mobile superficial layer; EF was confirmed at 40% with apical and inferior/inferolateral akynesia. Once admitted to the Cardiac Intensive Care Unit and stabilized, he underwent a coronary angiography which documented a trivascular coronaropathy without signs of acute obstruction. A few days later, his neurological condition suddenly deteriorated; an urgent CT scan evidenced a cerebellar involvement. Double antiplatelet therapy was prosecuted and an heparin-based anticoagulation was started, which the patient would continue at home. Eventually, he achieved a partial neurological recovery. Ventricular aneurysms are fearsome mechanical complications of ischemic cardiac disease, resulting from myocardial scarring with loss of thickness after the ischemic insult. As such, they represent a preferential site for blood stasis and thrombus formation. The aneurysm formation can be subtle and asymptomatic, due to progressive paradoxical expansion of the fibrotic wall over the repeated systolic cycles. Our patient came up against multiple episodes of cerebral ischemia provoked by embolized fragments of the superficial thrombotic layers, subjected to greater mobility. He also developed a ventricular arrhythmia. These complications are frequently associated with focal ventricular aneurysms. Early diagnosis and treatment of coronary obstruction and timely revascularization are essential to prevent such ominous evolutions of ischemic cardiac disease.