Case report
An 87 year-old woman with hypertension, diabetes, coronary artery disease, and an ischemic cardiomyopathy presented with acute coronary syndrome and cardiogenic shock. Prior to abrupt clinical deterioration, she had described angina and heart failure symptoms of two weeks’ duration. On presentation, she was hypotensive requiring vasopressor support along with laboratory evidence of multiorgan failure. Electrocardiography demonstrated biventricular paced rhythm with a lateral wall infarct.
She was admitted to the cardiac intensive care unit and a bedside transthoracic echocardiogram revealed apical and lateral wall akinesis as well as aortic valve thickening. Due to suboptimal visualization of the LV and anticipated need for mechanical circulatory support, UEA was administered to exclude LV thrombus prior to proceeding with coronary angiography. The bedside echocardiogram revealed possible pericardial effusion versus a prominent pericardial fat; however, with the use of UEA, a large, expansive lateral wall pseudoaneurysm with a narrow neck width of 1.1 cm was revealed (Figure 1). UEA also opacified the pericardial space, revealing a large pericardial effusion with extensive thrombus.