CONGRESS ABSTRACT

Summary A 69-year-old woman with chronic obstructive pulmonary disease (COPD) and a significant smoking history presented with severe dyspnea and chest pain, leading to urgent heart transplantation due to late complications of ST-elevation myocardial infarction (STEMI). Chronology Two weeks before hospitalization, she experienced dyspnea and chest pain, but an ambulance did not reach her residence. A week later, she independently sought care at Emergency Department X, where a prior STEMI was identified. Echocardiography revealed a severely dilated left ventricle with an ejection fraction (EF) of 20%. Coronary angiography showed ostial occlusion of the left anterior descending artery (LAD), unsuitable for revascularization. Her condition deteriorated, with low cardiac output, aneurysmal dilation, worsening mitral regurgitation, and acute pulmonary edema. Transferred to the cardiac ICU (CICU), imaging revealed a ventricular pseudoaneurysm due to delayed myocardial rupture. Mechanical support with an intra-aortic balloon pump (IABP) was initiated to stabilize her hemodynamics. Evaluation and Treatment With refractory heart failure unresponsive to medical therapies, the patient was urgently listed for heart transplantation. After two weeks of IABP support, she underwent successful transplantation. Postoperative care focused on monitoring for graft rejection, infections, and organ dysfunction. Discussion This case underscores the importance of recognizing late STEMI complications, such as myocardial rupture and pseudoaneurysm. Key aspects include: Complication Recognition: Early identification and mechanical support were crucial for stabilization. Interdisciplinary Collaboration: Coordination among CICU, surgeons, and transplant teams optimized outcomes. Post-Transplant Management: Long-term management of COPD and prevention of complications will be vital for recovery. Conclusion This case illustrates the critical need for multidisciplinary management and advanced interventions to address late STEMI complications, transforming a grim prognosis into a successful outcome through timely transplantation and innovative cardiac care.