A 53-Year-Old Man with Embolic Stroke and Left Ventricular Apical Aneurysm

Reason for referral: left ventricular (LV) dysfunction with apical aneurysm

Relevant history: 53-year-old man with recent embolic stroke

Social history: heavy alcohol use, 20 pack-year smoking history, immigration from Central America 15 years prior

Physical examination: right-sided facial weakness, dysarthria

Laboratory data: normal thyroid studies and protein electrophoresis, HIV negative

Imaging: echocardiography showed dilated and thin LV, apical aneurysm, ejection fraction of 28%, and no patent foramen ovale or vegetations; no obstructive disease on CT angiography; cardiac MRI showed subendocardial late gadolinium enhancement (LGE) of midwall and transmural enhancement of apex (see Figure 1)

EKG: sinus bradycardia, T-wave in…