Unexpected echocardiographic findings in one vessel coronary artery disease

Abstract

Introduction Left ventricular aneurysm is one of the most significant complications of myocardial infarction and it is thought to develop in 5–10% of all patients with acute myocardial infarction. Case report A 50-year-old male patient with a history of chronic alcohol abuse and risk factors for coronary heart disease was treated twice in the regional hospital center because of heart failure. Initially, echocardiography was not performed. Three years later he was admitted to the Urgent Center with a chief complaint of chest pain. He was evaluated by echocardiography, which showed a scar affecting the inferior wall of the left ventricle with an aneurysm on its basal portion which contained a thrombus. The patient also underwent transesophageal echocardiography which confirmed that there was a rupture of the commissural chordae tendineae of the posterior mitral leaflet with severe regurgitation. In consideration of these findings, the patient was referred to undergo coronary angiography, which revealed single vessel coronary artery disease. The patient subsequently underwent cardiac surgery for mitral valve replacement with an artificial valve, along with repair of the left ventricular aneurysm. Conclusion With consideration of his history of alcohol abuse, our patient likely experienced a silent inferior-basal myocardial infarction complicated by the development of an aneurysm of the ventricular wall. Subacute bacterial endocarditis may have been a contributing factor leading to infarction and rupture of the mitral valve chordae tendineae, and causing symptoms of heart failure and chest pain in our patient. © 2017 The Czech Society of Cardiology