Isolated non-compaction of the myocardium as a cause of coronary and cerebral embolic events in the same patient

A 44-year-old woman with a history of smoking and previous cerebral thrombo-embolism presented to the emergency department with prolonged chest pain and ECG changes showing an acute anterior myocardial infarction. She was referred to the cath-lab for primary angioplasty. Coronary angiography showed a thrombotic occlusion at the origin of first diagonal branch without evidence of coronary stenoses in the other vessels (Panel C, arrow). The thrombus was removed using a thrombus extraction catheter (Pronto®, Vascular Solutions, Inc., Minneapolis, MN, USA) and TIMI III flow was restored without residual coronary stenosis. Two-dimensional echocardiography with intravenous echo contrast showed an enlarged left ventricle with severe left ventricular dysfunction (EF 30%). In addition, prominent trabeculations (T) and deep intratrabecular recesses at apical posterolateral wall were present (Panels E and F) suggesting the diagnosis of left ventricular non-compaction of the myocardium (LVNC). Cardiac magnetic resonance imaging (CMRI) confirmed the diagnosis of LVNC with a small apical thrombus (t) within the uncompacted layer of the myocardium. Delayed enhanced images showed an anteroapical infarct scar area (S) (Panels I and L). In addition, mild pericardial effusion was noted. Patient was discharged on ramipril, carvedilol, and oral anticoagulation with acenocumarol. As left ventricular dysfunction remains unchanged 3 months after discharge, implantation of cardioverter defibrillator is planned.