Introduction: Heart failure (HF) is a severe complication of myocardial infarction, it can cause a mortality up to 50% during hospitalization time. Late presentation, infarct size, mechanical complications are some of the predictive factors for HF. In cases with late presentation, therapy with drugs that prevent left ventricular (LV) remodelling and surgical LV reconstruction can improve prognosis.
Case presentation: A 63 years old female, non smoker, without previous cardiovascular disease, presents with paroxysmal nocturnal dyspnea, fatigue and lower limb edema, symptoms that occurred in the last 3 weeks af-ter an episode of prolonged chest pain. Physical exam reveals heart failure signs- systemic congestion, bilateral pleural effusion, increased heart size, LV gallop sound, BP=100/70 mmHg. On ECG an extended ante-rior myocardial infarction with frozen ST elevation and bifascicular block (RBBB and anterior fascicular block) are noticed. On transthoracic echocadiogram a large LV apical aneurysm (60% of LV) is noticed with severe LV systolic dysfunction, an EF of 10-15%, moderate ischemic mitral regurgitation and secondary pulmonary hypertension (PAP=55 mmHg).Therapy for HF is initiated with beta blockers, diuretics, later with positive inotropic drugs and drainage of pleural effusion. Acute kidney injury and ischemic hepatic damage occured. Coronary angiography showed LAD occlusion from its origin and normal aspect of other vessels. Patient was sent to anther center for LV reconstruction (Dor endoventricular patch plasty) and mitral annuloplasty. After surgery severe complications occurred cardiogenic shock, acute liver- kidney injury and arrhythmia VT, VF. Patient is discharged 1 month after surgery in good clinical condition. LV volume decreased form 278 ml la 140 ml and EF increased to 30%.
Conclusions: Pharmacological therapy together with LV reconstruction (endoventricular patch plasty) and mitral annuloplasty improved LV function and patient’s prognosis after STEMI.