Atypical Presentation of Chronic Left Anterior Descending Occlusion: Heart Failure Without Angina as the Initial Manifestation

Figures

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  Figure 1. Apical four-chamber view showing severe left ventricular systolic dysfunction Apical four-chamber transthoracic echocardiographic view obtained in systole demonstrating severe global left ventricular systolic dysfunction, with markedly reduced cavity obliteration and minimal inward myocardial motion. The left ventricle and left atrium are significantly dilated. The interventricular septum appears thinned, akinetic, and hyperechogenic, consistent with chronic ischemic injury. The right-sided chambers are also enlarged. Overall, the image illustrates advanced dilated remodeling with profoundly impaired contractility, corresponding to the patient’s severe heart failure presentation.

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  Figure 2. Bull’s-eye plot demonstrating severe reduction in global longitudinal strain Bull’s-eye plot of left ventricular global longitudinal strain showing severely reduced myocardial deformation, with a global strain value of –4.1%. Most myocardial segments exhibit markedly impaired or near-absent strain, with the most pronounced abnormalities localized in the anterior and septal regions. The uniform red-to-pink pattern reflects diffuse systolic dysfunction, consistent with the severely reduced left ventricular ejection fraction (18%). This strain map supports the presence of advanced chronic ischemic cardiomyopathy. ANT, anterior; SEPT, septal; LAT, lateral; INF, inferior; POST, posterior

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  Figure 3. Parasternal long-axis echocardiographic view showing severe left ventricular dilatation and global systolic dysfunction Parasternal long-axis transthoracic echocardiographic view demonstrating a markedly dilated left ventricle with severely reduced systolic thickening and minimal inward myocardial motion. The interventricular septum appears thinned and akinetic, consistent with chronic ischemic remodeling, while the posterior wall exhibits only limited contractility. The left atrium is enlarged, and the aortic root and mitral valve structures remain anatomically preserved, although functional impairment is present secondary to ventricular dilatation. These findings illustrate advanced dilated cardiomyopathy with profound systolic dysfunction, correlating with the patient’s severely reduced ejection fraction.