Noncompaction and embolic myocardial infarction: the importance of oral anticoagulation

Area of Science:

• Cardiology
• Internal Medicine
• Pathology

Background:

• Left ventricular noncompaction (LVNC) is a rare cardiomyopathy defined by excessive left ventricular (LV) trabeculations.
• LVNC is associated with increased risks of heart failure, arrhythmias, and embolic events.

Observation:

• A 67-year-old patient with LVNC, previously on oral anticoagulation (OAC) for apical thrombosis, discontinued OAC therapy.
• Following OAC cessation, the patient developed extensive left ventricular thrombosis, worsening cardiac function, and requiring hospitalization.

Findings:

• Despite heparin treatment, the patient suffered a myocardial infarction (MI) attributed to embolic occlusion of the left anterior descending artery.
• This case suggests coronary thromboembolism from dislodged LV thrombus as a cause of MI in LVNC, distinct from typical microvascular dysfunction.

Implications:

• This case highlights the critical role of anticoagulation in managing LVNC patients with thrombosis.
• It underscores the potential for LVNC-associated thrombosis to cause significant embolic complications, including myocardial infarction.
• Further research into optimal anticoagulation strategies for LVNC patients is warranted.