P194 AN UNUSUAL PRESENTATION OF ST–SEGMENT ELEVATION MYOCARDIAL INFARCTION: LEFT VENTRICULAR THROMBOSIS AND ISCHEMIC STROKE

Abstract

Abstract Background Patients with large anterior MI associated with a reduced systolic function are at increased risk for developing left ventricular thrombosis. Stasis of blood in the ventricular cavity and the inflammation associated with ischemic injury are the causes of left ventricular thrombosis and increased risk of stroke. It usually develops within the first week and often the first day after infarction. Embolization takes place during the first 1 to 3 months. Our patient presented a very early embolization. Case Report A 70–year–old smoker man, without other cardiovascular risk factors, presented at the emergency department of our hospital with acute aphasia and right facio–brachio–crural hemiparesis. The 12–lead ECG revealed ST–elevation in V2–V5 and Q waves in V1–V3. Patient was asymptomatic for angina at the time of presentation and the days before. He performed an urgent head–CT that revealed proximal occlusion of the M2 tract of left middle cerebral artery cause of ischemic stroke (NIHSS 13). Then, he underwent per–cutaneous mechanical thrombectomy with complete re–canalization of the vessel. Immediately after he performed coronary angiography that showed the occlusion of anterior inter–ventricular artery treated by angioplasty and implant of drug eluting stent. Both procedures have been well tolerated by the patient without complications. Measurements of high–sensitivity cardiac Troponin demonstrated a peak and following fall of the values. A two–dimensional echo–cardiogram showed akinesia of anterior wall and apical segments of LV with EF < 40% and ventricular thrombus. A multidisciplinary team evaluated evolution of cerebral ischemic lesion and patient’s clinical conditions and established the correct time and management of therapy with DAPT (aspirin+clopidogrel) and VKA. It has been prescribed three months DAPT+VKA therapy and later DAT (aspirin+VKA) for one year. Patient has been discharged with minor aphasia, without cardiac symptoms and good hemodynamic status. Conclusion Left ventricular thrombosis is a frequent complication of anterior MI. The optimal frequency of follow–up imaging and time of treatment are not known. Our patient had a very early presentation. It should be useful to have guidelines to prevent and treat left ventricular thrombosis. Despite common use of anticoagulant drugs in the treatment of left ventricular thrombosis, there aren‘t randomized clinical trials evaluating the safety and efficacy of this strategy.