利用腺苷负荷门控心肌显像的心功能参数指标评价陈旧性心肌梗死患者的心功能

目的探讨利用腺苷负荷门控心肌灌注显像的心功能参数评价陈旧性心肌梗死(OMI)患者心功能和预后的价值。方法OMI组16例,正常对照组18例,两组均进行99m锝标记甲氧基异丁基异腈(99Tcm-MIBI)腺苷负荷门控灌注显像,分析对比两组间的左室射血分数(LVEF)、舒张末期容积(EDV)、收缩末期容积(ESV)及左室壁运动情况。结果OMI组的LVEF(57.00±23.42)%低于正常对照组(76.44±11.68)%,而左室容积参数EDV明显大于正常对照组(133.00±87.96)ml vs(67.11±19.21)ml和ESV(73.97±83.15)ml vs(17.17±11.36)ml;三维心室运动图像观察发现9例(56.3%)OMI患者出现室壁运动减弱;两组间心功能参数经统计学分析差异均有统计学意义(均P<0.05)。结论腺苷负荷门控心肌灌注显像中测得的功能参数是评价左室功能的重要指标,其对陈旧性心肌梗死患者的心功能评价、疗效观察及预后判定均有重要意义。     

实时三维超声心动图对心肌梗死患者左心室重构的评价

目的 应用实时三维超声心动图评估心肌梗死患者的左心室重构.方法 冠心病(CAD)患者54 例,年龄(60.83 ±8.58 )岁.健康对照组17 例,年龄(57.08 ±9.69 )岁.全部研究对象经心电图与冠状动脉造影证实.实时全容积三维图像的采集用Philips Sonos 7500 型超声心动图仪,测量应用TomTec 三维工作站.计算左心室心肌质量(LVM)、左心室心肌质量指数(LVMI)、左心室舒张末容积(EDV)、收缩末容积(ESV)及射血分数(EF).结果 与对照组比较,心绞痛组的各参数没有明显改变(P ＞0.05 ).急性心肌梗死(AMI)组与陈旧性心肌梗死(OMI)组的LVM 、LVMI 、EDV 、ESV 均增加,EF 值明显降低(P ＜0.05 ).结论 实时三维超声心动图对评估心肌梗死患者的左心室重构有临床价值.     

心肌磁共振显像、核素心肌灌注显像和超声心动图测定左心功能的对比研究

目的评价心肌磁共振显像(MRI)、门控核素心肌灌注显像(SPECT)和超声心动图(Echo)检测急性心肌梗死(AMI)患者左心室功能的应用价值。方法AMI患者23例,分别于一周内行MRI、SPECT及Echo三项检查,测定左室舒张末期容积(EDV)、收缩末期容积(ESV)和射血分数(EF),将MRI检测结果作为标准,并与SPECT及Echo结果比较,行相关分析及一致性检验。结果MRI采用多层Simpson法,图像空间分辨率高,可以准确划分血池和心肌的界限。SPECT较MRI低估左室容积EDV15.9ml,ESV8.3ml,EF值两者大致相等。Echo较MRI低估左室容积EDV53.2ml,ESV33.0ml,高估EF5.3%。经相关分析,SPECT与MRI所测EDV、ESV、EF相关系数分别为0.79、0.84、0.84(P均<0.001),Echo与MRI所测EDV、ESV、EF相关系数分别为0.54(P<0.01)、0.43(P<0.05)、0.63(P<0.01)。经Bland-Altman一致性检验,SPECT与MRI所测左室容积及射血分数有等价性。结论MRI检测心功能准确、可靠。SPECT与MRI具有等价性。Echo左心功能测值较MRI有明显偏倚,需进一步改进检测方法以提高准确性。     

实时三维超声心动图评价高血压肥厚型心肌病患者左心室节段收缩功能

目的采用实时三维超声心动图(RT-3DE)评价高血压肥厚型心肌病(HHC)患者左心室节段收缩功能.方法 选择HHC患者30例,健康人32名.在心尖四腔观,应用全容积显像方式采集RT-3DE图像,显示左心室17节段的容积-时间曲线,获得左心室收缩功能参数:左心室舒张末期容积(EDV)、收缩末期容积(ESV)和左心室射血分数(LVEF),左心室17节段收缩容积变化比值即ESV/EDV,左心室16节段心率校正后达到收缩末期最小容积时间的标准差(Tmsv16-SD)和时间的差值(Tmsv16-Dif).结果 HHC组较正常对照组整体EDV及ESV明显增大,且差异有统计学意义[(88±29)ml vs (72±15) ml,t=-2.680,P=0.008;(28±10)ml vs (22±6)ml,t=-2.613,P=0.01],而LVEF的差异无统计学意义[(67±7)% vs (68±5)%,t=-0.261,P=0.795].HHC组较正常对照组室间隔中段及心尖段收缩容积变化比值明显增大,且差异有统计学意义[前室间隔中段:(40.51±20.28)% vs (26.43±10.10)%,t=-3.378,P=0.002;后室间隔中段:(41.44±23.55)% vs (24.46±8.12)%,t=-3.688,P=0.001;室间隔心尖段:(30.96±21.31)% vs (19.53±7.33)%,t=-2.745,P=0.01].HHC组与正常对照组比较,左心室Tmsv16-SD及Tmsv16-Dif明显增加,且差异有统计学意义[Tmsv16-SD:(2.48±1.38)% vs (1.16±0.26)%,t=-5.117,P＜0.001;Tmsv16-Dif:(7.67±5.07)% vs (3.95±1.48)%,t=-3.865,P＜0.001].HHC组和正常对照组左心室收缩不同步发生率分别为43%及3%.结论 HHC患者左心室整体收缩功能降低之前可能已存在室壁节段收缩功能受损,左心室收缩同步性异常发生率较高,RT-3DE是评价HHC患者左心室心肌收缩功能有价值的方法.     

三维斑点追踪技术评价阻塞性睡眠呼吸暂停综合征患者左心室收缩功能

目的应用三维斑点追踪技术评价阻塞性睡眠呼吸暂停综合征(OSA)患者左心室收缩功能。方法应用三维斑点追踪技术对经昼夜多导睡眠监测仪确诊的OSA患者[根据睡眠呼吸暂停指数(AHI)>5次/h]39例和所有检测指标正常的正常对照组45例进行左心室心肌斑点追踪分析,比较两组的BMI、左心室射血分数(LVEF)及左心室三维应变指标,并且分析比较AHI、BMI与三维应变指标之间的相关性。结果 (1)与正常人比较,OSA患者的BMI、左心室舒张末期容积(EDV)、左心室收缩末期容积(ESV)均明显增大(P<0.05);OSA患者左心室三维环向、径向应变值较正常人有明显减小(P<0.05);(2)相关性分析:BMI与EDV、ESV、长轴应变、径向应变、扭转、扭转度有较好的相关性:EDV(r=0.523,P<0.01),ESV(r=0.617,P<0.01),长轴(r=-0.402,P<0.01),环向(r=-0.284,P>0.05),径向应变(r=-0.423,P<0.01),扭转(r=-0.370,P<0.05),扭矩(r=-0.419,P<0.01)。结论三维应变参数能够敏感反映OSA患者左心功能改变,其中三维环向及径向应变能够在患者LVEF发生改变之前反映心功能的变化且左心功能的改变与BMI有关。     

左室容积分析技术评价代谢异常对肥胖者左心室几何形态及同步性的影响

目的应用左室容积分析技术评价伴或不伴代谢异常的肥胖者的左心室几何形态和同步性变化。方法将67例肥胖者按是否伴有代谢异常分为代谢正常型肥胖组(MHO组)和代谢异常型肥胖组(MUO组),选择40例同期年龄、性别匹配的健康体检者作为对照组。应用LVA技术获得左室舒张末容积(EDV)、收缩末容积(ESV)、每搏量(SV)、射血分数(EF)及舒张末球形指数(EDSI)、收缩末球形指数(ESSI)、舒张期失同步指数(DDI)、收缩期失同步指数(SDI),经体表面积标化后获得左室舒张末期容积指数(EDVI)、收缩末期容积指数(ESVI)。结果与对照组比较,MHO组和MUO组的左室EDV、ESV、SV、EDVI、ESVI、EDSI、ESSI、DDI、SDI增加(P0.05);与MHO组比较,MUO组的左室DDI、SDI增加(P0.05),但左室EDV、ESV、SV、EDVI、ESVI、EDSI、ESSI无统计学差异(P0.05);三组间的EF无统计学差异(P0.05)。结论肥胖者左心室各相容积增加,几何形态趋于球形转变,左室心肌运动同步性减低,代谢异常加重损害其左室同步性运动。     

超声心动图评价肥厚型心肌病和高血压左心室肥厚患者左心房收缩功能

研究背景 心肌梗死后,左心室局部及整体心肌运动障碍,收缩功能降低。准确评价心肌梗死后左心室整体及节段心功能的改变对指导治疗及判断预后具有重要的临床意义。与传统M 型和二维超声技术相比,实时三维超声心动图(RT-3DE)技术不仅可以客观地显示整个心脏的形状和运动状态,而且可以对各节段心肌的容积及运动状态进行定量分析,具有独特的优势。目的 运用RT-3DE技术定量评价陈旧性前壁心肌梗死患者左心室整体及节段收缩功能改变,初步探讨其临床应用价值。方法 采用PhilipsiE33彩色多普勒超声成像仪,配备X3-1探头(1~3MHz)和Qlab6.0定量分析软件,检查25名正常人与20例陈旧性前壁心肌梗死患者,获取左心室整体和17节段容积-时间曲线及17种不同色彩的“牛眼图”,并将超声图像信息储存于硬盘上脱机分析。获取左室整体及各节段舒张末期容积(EDV、rEDV)和整体及各节段收缩末期容积(ESV、rESV);在由公式:rEF= [(rEDV -rESV)/rEDV]×100%,rgEF= [(rEDV-rESV)/EDV]×100%计算出整体及局部射血分数(EF、rEF)和局部-整体射血分数(rgEF)。然后比较两组整体和节段舒张末期容积(EDV、rEDV)、收缩末期容积(ESV、rESV)、射血分数(EF、rEF)及节段整体射血分数(rgEF)是否具有统计学差异。结果与正常组比较,陈旧性心肌梗死组整体EDV、ESV及梗死节段rEDV、rESV较对照组增大,整体EF和梗死节段rEF、rgEF降低(P<0.05);心尖部rEDV、rESV 增大,rEF、rgEF较对照组降低(P<0.05);非梗死节段中部分节段rEF、rgEF较正常组增大(P<0.05),余节段无明显差异。结论 心肌梗死后,左心室重构,左心室整体舒张末期容积和收缩末期容积增大,左心室整体、梗死节段及心尖部收缩功能下降,部分未梗死节段心功能代偿性增强。RT-3DE可准确定量评价心肌梗死后左心室整体及局部容积及收缩功能的改变。     

三维超声心动图定量评价扩张型心肌病左心室舒张功能

目的 探讨三维超声心动图(3DE)定量评价扩张型心肌病(DCM)左心室舒张功能的可行性.方法 对30例DCM患者(DCM组)和30名正常人(对照组)进行超声心动图检测,测量左心室舒张末期容积(EDV)、左心室收缩末期容积(ESV)和每搏输出量(SV)及射血分数(EF),并计算左心室舒张期前1/3充盈分数(1/3FF);分析1/3FF与E/E的相关性.结果 DCM组EDV、ESV、SV及E/E显著高于对照组(P均＜0.05);DCM组EF及1/3FF显著低于对照组(P均＜0.05);两组的1/3FF与E/E均呈显著负相关(r=-0.81、-0.81,P均＜0.05).结论 3DE能定量评价DCM左心室舒张功能,可作为临床评价左心室舒张功能的一种新方法.     

急性心肌梗死患者肌钙蛋白I水平及其与室壁瘤形成关系的研究

目的 通过测定急性心肌梗死(AMI)患者早期血浆心肌肌钙蛋白I(cTnI)水平变化,结合导管法左心室造影(LVG)心室容积、压力及形态的变化,探讨cTnI在AMI后急性室壁瘤(LVA)形成患者血浆中的动态变化特点及其与LVA形成和心功能状态的关系.方法 选择首次前壁AMI患者62例,根据入院即刻LVG结果将患者分为LVA形成组29例和无LVA组33例.所有受试者于发病后12小时采血检测cTnI.所有患者于经皮冠状动脉介入治疗(PCI)完成后即刻及6个月复查时均行LVG,测定左心室舒张末期容积指数(LVEDVI)、左心室收缩未期客积指数(LVESVI)、左心室射血分数(LVEF)、室壁运动记分(WMS)、左心室舒张末期压(LVEDP).随访6个月内主要恶性心脏事件(MACE)的发生率.结果 LVA形成组自AMI发作至再灌注时间较无LVA组明显延长(9.06±5.23)hVS(6.76±4.27)h(t=2.351,P<0.05)、同时Killip Ⅲ级心力衰竭发生率明显高于无LVA组(27.6%WS 3.0%,x=7.501,P<0.01).LVA形成组血浆cTnI峰值浓度明显高于无LVA组(158.28±15.39)pg/L vs(149.15±14.62)pg/L(t:2.212,P<0.05).PCI后即刻和术后6个月时,无LVA组LVEF、LVESVI、LVEDVI、WMS和LVEDP各参数均优于有LVA形成组(均P<0.05).LVA形成组患者在6个月随访期间MACE发生率明显高于无LVA组患者[13(44.8%)vs 4(12.1%),x2=6.732,P<0.01],且cTnI峰值水平与MACE发生率显著相关(r=0.561,P<0.05).结论 血浆cTnI水平在AMI后LVA形成患者中明显高于无LVA者,且与左心室重构程度和血流动力学变化密切相关,提示心肌坏死标记物cTnI的大量释放参与了AMI后LVA的形成过程,并影响着AMI后左心室重构和LVA的进程.     

实时三维超声心动图对比评价正常右心室及左心室功能

目的 观察利用实时三维超声心动图(RT-3DE)评估、比较成年人正常心脏左右心室的可行性,并探讨左右心室之间的关系.方法 应用RT-3DE全容积成像采集58名心脏正常成年人的心脏三维数据,在TomTec工作站中分析获得右心室舒张末期容积(EDV)、收缩末期容积(ESV)、每搏输出量(SV)和射血分数(EF);在Qlab工作站中分析获得左心室舒张末期容积(EDV)、收缩末期容积(ESV)、每搏输出量(SV)和射血分数(EF).结果 右心室EDV[(85.84±20.82)ml]、ESV[(41.87士10.48)ml]分别大于左心室EDV[(69.37士17.83)ml]、ESV[(26.46±8.26) ml](P均＜0.001),而右心室EF[(50.94士5.57)％]小于左心室EF[(61.97±6.48)％,P＜0.001].左心室SV[(42.91±11.72) ml]与右心室SV[(43.96±12.15) ml]差异无统计学意义(P=0.273).左右心室的对应参数均有相关性.结论 RT-3DE是评估左右心室容积和功能的可行方法,且其相应参数在左右心室间是相关的.     

Significance of inducible ventricular flutter-fibrillation after myocardial infarction

Aim: The purpose of this study was to determine the factors associated with the induction of ventricular flutter/fibrillation (VFl/VF)and its prognostic significance in post-myocardial infarction. METHODS: Programmed ventricular stimulation was performed after myocardial infarction (MI) for syncope (n = 232) or systematically (n = 755); 230 patients had an induced VFl/VF and were followed during 4 +/- 2 years. RESULTS: VFl/VF was induced in 49/232 patients (21%) with syncope versus 181/755 asymptomatic patients (24%) (NS) and 94/410 patients (23%) with left ventricular ejection fraction (LVEF) <40% versus 136/577 patients (22.5%) with LVEF >40% (NS). Cardiac mortality was 9%; LVEF was 33 +/- 15% in patients who died, 43 +/- 13% in alive patients (P < 0.004). In patients with LVEF <40%, induced VFl/VF, mortality rate was 31% in those with syncope, 10% in asymptomatic patients (P < 0.001), because of an increase of deaths by heart failure; patients with LVEF >40% with or without syncope had a low mortality (5% and 3%). After linear logistic regression, VFl/VF and LVEF were predictors of total cardiac mortality, but only LVEF <40% predicted sudden death. CONCLUSION: Syncope and the level of LVEF did not increase the incidence of VFl/VF induction after MI, but modified the cardiac mortality: induced VF increased total cardiac mortality in patients with syncope and LVEF <40%, but did not increase sudden death. In patients with LVEF >40%, induced VFl/VF has no significance neither in asymptomatic patients nor in those with syncope.     

Morphologic left ventricular patterns and prevalence of high-grade ventricular arrhythmias in the normotensive and hypertensive elderly

In the elderly, systemic hypertension is the main risk factor for cardiovascular diseases. Left ventricular hypertrophy, the most common adaptation to chronic pressure overload, has been recognized as an independent risk factor for an increased incidence of sudden death and arrhythmic disturbances. This study compared the prevalence of serious ventricular arrhythmias in elderly individuals with uncomplicated hypertension and in normotensive age-matched controls, using left ventricular mass index (LVMI) to differentiate patterns of anatomic adaptation to systolic, diastolic, or systolic-diastolic hypertension. The study enrolled 378 con-secutive untreated elderly subjects (≥65 years of age), without clinical evidence of heart failure; 203 were hypertensive and 175 were normotensive. Each participant underwent standard 12-lead electrocardiography, M-mode and B-mode echocardiography, and 24-hour ambulatory electrocardiographic monitoring. Serious, statistically significant arrhythmias (Lown classes ≥3) were present in 6.8% of normal subjects versus 17.1% of individuals with systolic, 31.5% of those with diastolic, and 20.4% of participants with systolic-diastolic hypertension. Arrhythmias did not differ in terms of left ventricular morphologic patterns or LVMI or between subgroups of hypertensive patients. Our data support the hypothesis that the pathogenesis of arrhythmias is related not to the electrophysiologic derangement of hypertrophied muscle but, rather, to the effects of hypertension on the cardiac structure. Cardiac fibrosis, one of the deleterious events accompanying hypertension, may be the main substrate for ventricular arrhythmias.     

The repetitive ventricular response: relationship to ventricular fibrillation threshold in dogs

The experiments investigated the hypothesis that the occurrence of repetitive ventricular responses elicited by the ventricular extrasystole (VES) technique are an indicator of ventricular vulnerability to fibrillation. A comparison was made between the incidence of repetitive responses elicited by the VES technique and the minimum electrical energy (VFT technique) necessary to elicit repetitive responses and ventricular fibrillation in normal dogs, dogs with acute infarction, and dogs with chronic infarction. The VES technique produced repetitive responses in 14 of 46 sites. Responses were of at least three types: (1) bundle branch re-entry; (2) activation at the pacing site, and (3) activation at the infarct zone. In contrast repetitive responses and the onset of fibrillation produced by the VFT technique appeared to be a single type with earliest activation at the pacing site. There were no differences in the ventricular fibrillation thresholds between dogs with and without repetitive responses produced by the VES technique. Thus the incidence of VES technique-induced repetitive responses is not a reasonable predictor of ventricular vulnerability to fibrillation. However, in 2 dogs with lower ventricular fibrillation thresholds, repetitive responses originating at the infarct zone were induced by the VES technique. Occurrence of these repetitive responses may be indicative of ventricular vulnerability to fibrillation.     

核素心室显像对前壁、下壁急性心肌梗死左室局部收缩功能的评价

目的 :评价前壁及下壁急性心肌梗死 (AMI)左室局部收缩功能。方法 :于AMI发病后第三周应用门控平衡法核素心室显像检测两壁左室整体及局部射血分数 (LVEF、rEF) ,轴缩短率 (RS) ,局部轴缩短率 (rRS)。结果 :前壁组LVEF (31 5 3± 10 38% )显著低于下壁组(46 5 2± 8 6 5 % ) ,P <0 0 1;前壁组平均室壁运动积分 (1 86± 0 6分 )亦显著低于下壁组 (2 2 0± 0 6分 ) ,P <0 0 1。结论 :AMI急性期左室局部收缩功能和室壁运动状态均与梗死部位有关。前壁AMI左室收缩功能受损程度较下壁AMI更为显著。     

Adenosine induced atrial fibrillation precipitating polymorphic ventricular tachycardia

An 86-year-old female developed supraventricular tachycardia 36 hours after a myocardial infarction (MI). She developed atrial fibrillation and polymorphic ventricular tachycardia (PVT) following administration of 12 mg of adenosine. The PVT caused hemodynamic instability with no response to cardioversion, but termination with procainamide. The heart is vulnerable to hemodynamically unstable, possibly lethal, PVT early after MI under some circumstances. This vulnerability may be exposed following administration of adenosine. Extra caution is warranted when using adenosine in the post-MI period.     

右心室合并急性下壁心肌梗死患者临床特点分析

目的 探讨ST段抬高急性下壁心肌梗死（IWMI）伴或不伴右心室心肌梗死（RVMI）患者的临床特点。方法前瞻性研究92例急性IWMI患者的临床特点，根据入院时心电图V4R-V6R导联ST段是否抬高将患者分为IWMI合并RVMI组（34例）和单纯IWMI组（58例）。比较两组患者在主要危险因素、临床表现、治疗和并发症方面的差异。结果①单纯IWMI患者较IWMI合并RVMI患者有较高的冠心病家族史（P〈0．05）。②IWMI合并RVMI的惠者出现低血压、颈静脉怒张和Kussmaul征的比例明显增加（均为P〈0．01）。③IWMI合并RVMI患者需要更多的容量负荷（P〈0．01）和应用正性肌力药物维持血压（P〈0．01）。④IWMI合并RVMI患者有较高的病死率（P〈0．05）。结论与单纯IWMI患者比较。IWMI合并RVMI患者冠心病家族史较少，低血压、颈静脉怒张、Kussmaul征均较常见。病死率较高，治疗上更多需要容量负荷和应用正性肌力药物。     

Showing up channels for postinfarct ventricular tachycardia ablation

The number of scar-related ventricular tachycardia (VT) ablation procedures is increasing worldwide. This is certainly due to the ever growing number of patients implanted with an implantable cardioverter defibrillator in whom an ablation procedure may be required to better control the ventricular arrhythmia burden, but is also likely related to our better understanding of the arrhythmias mechanisms as well as the improvement of the mapping techniques during the last 15 years. Most VTs, especially those arising after myocardial infarction, depend on a critical isthmus. Defining precisely the critical isthmus of postinfarct VT may be challenging, particularly when the arrhythmia is poorly tolerated. In the literature, there are extensive data concerning the value of conventional electrophysiological techniques, especially entrainment mapping in association with postpacing interval measurements, regarding the identification of postinfarct VT isthmuses. There are, however, other--sometimes emerging--approaches to image critical postinfarct VT channels. We have summarized these, reviewing data from the published literature as well as our own experience.     

左心室整体纵向应变预测急性心肌梗死患者经皮冠状动脉介入术后左心室重构

目的 探讨应用二维斑点追踪(STE)技术预测急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)术后左心室重构(LVR)的价值。方法 对75例AMI患者于PCI术后72 h及6个月行STE检查,测算左心室整体圆周应变(GCS)及整体纵向应变(GLS)。以术后6个月左心室舒张末期容积(LVEDV)≥15%作为LVR诊断标准。进行统计学分析。结果 PCI术后6个月,75例中56例未发生重构(非重构组),19例发生LVR(重构组),发生率25.33%(19/75)。与术后72 h比较,重构组术后6个月LVEF减低,非重构组术后6个月LVEF增高(P均<0.05)。与非重构组比较,重构组术后72 h及术后6个月GCS及GLS均减低(P均<0.05)。LVEF、GCS及GLS均与LVR呈负相关(r=-0.39、-0.52、-0.64,P均<0.01)。GLS及GCS是LVR的独立预测因子。GLS的ROC曲线下面积最大,预测LVR的阈值为-12.45%,敏感度和特异度分别为86.3%及87.2%。STE参数测量观察者间差异为(9.32±3.14)%,观察者内差异为(7.18±2.26)%。结论 通过STE测得的GLS可用以准确预测AMI患者PCI术后LVR。     

Myocardial recovery: a focus on the impact of left ventricular assist devices

Heart failure remains one of the most prevalent diseases worldwide and in recent decades, left ventricular assist devices (LVADs) have become an important treatment option. With increasing device experience, there is particular interest in the use of LVADs as a bridge to recovery that allows the patient’s heart to undergo reverse remodeling, whereby the device can be explanted and the heart can function at an improved state. There are many considerations that play a role in this process, including the ability of the device to unload the heart, the innate physiology of the heart to recover and the use of concomitant therapies. This review provides an overview of the most current literature as it pertains to these processes and gives a view into the future directions of LVADs as a tool for achieving myocardial recovery.     

Left ventricular pseudoaneurysm causing myocardial infarction and cerebrovascular accident

Although post-infarction mortality is most often due to ventricular dysrhythmias, the non-dysrhythmic causes of post-myocardial infarction death present a potential dilemma to the clinician. Non-dysrhythmic hemodynamic complications include cardiogenic shock, left ventricular free wall rupture, rupture of the interventricular septum, papillary muscle rupture, left ventricular pseudoaneurysm, and acute stroke. We present a rare case of a left ventricular pseudoaneurysm presenting with altered mental status, ultimately suspected to have caused the thromboembolic complications of acute myocardial infarction and cerebrovascular accident.