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A3494 - Ventricular Non Compaction: Part of a Stroke Victim's Dictionary
Author Block: S. Khauli1, P. Thalanayar Muthukrishnan2, S. Girotra3; 1Internal Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, United States, 2Pulmonary and Critical Care, Case Western Reserve University, Lakewood, OH, United States, 3Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, United States.
Introduction: Stroke is a very common and serious condition in neuro-critical care. Although the central nervous system is the main site of the disease, neuro-critical care intensivists are sometimes challenged by the systemic manifestations that may result from stroke. Left ventricular noncompaction cardiomyopathy (LVNC) is a rare form of cardiomyopathy that may develop in stroke victims.
Case Presentation: A 60-year-old man, with a past medical history of hypertension and diabetes, was admitted to the hospital with palpitations, chest pain, decreased vision in his right eye, bilateral lower limbs weakness and dysarthria, which started a few hours prior to his admission. He was afebrile, blood pressure was 124/75, oxygen saturation was 96% on room air and pulse rate was 130 per minute which was regular. His electrocardiogram showed atrial flutter with 2:1 Atrio-Ventricular (AV) Block. A brain MRI showed acute numerous small foci of infarcts involving the frontal, parietal, and occipital lobes bilaterally consistent with embolic phenomena. A transthoracic echocardiogram showed moderate concentric hypertrophy with an ejection fraction (EF) of 35%. Left ventricular noncompaction cardiomyopathy (LVNC) was identified on the presence of deep intratrabecular recesses and ratios of compacted to non-compacted myocardium of more than 2:1 at end-systole. A TEE did not show evidence of left atrial appendage clots. He was started on heart failure medications and anticoagulation in addition to his standard stroke care, and discharged later from the hospital in stable condition.
Discussion: LVNC is characterized by left ventricular trabeculae and deep inter-trabecular recesses. It can be seen as an isolated finding as well as in syndromes with other congenital cardiac abnormalities. So far, a gold standard set of criteria for diagnosing this condition is lacking, and morphologic criteria are evolving for that purpose. Anticoagulation is suggested by other studies to decrease the risk of thromboembolism, especially in patients with atrial fibrillation who otherwise have low thromboembolic risk. Even though the 2D transthoracic echocardiogram is still the most commonly used modality for diagnosis of LVNC, it’s still missed in a significant size of population. Our patient in this case had a prior echocardiogram, but no diagnosis of LVNC was reported. Although there is controversy about the association of LVNC with non-cardiac disease, many case reports and case series reported this association. Further studies to address this issue are very important.