Echocardiography showed anterior, septal, apical and anterolateral wall
hypokinesia with two apical thrombus measures
1110
cm
,1012
cm subsequently with moderately impaired left ventricular systolic
function (Ejection Fraction=34) favoring the decision of adding
furosemide 40 mg tabs once daily and spironolactone tabs 25 mg once
daily. See Figure 1
The patient was followed up closely symptomatically with serial ECGs on
the subsequent days showing significant improvement until day 4 of
Admission in the evening follow up when he was found to have slurred
speech and he mentioned that he was unable to move his right side,
without mouth deviation, headache or blurring of vision. On examination
he was afebrile, conscious, oriented in time, place and person. There
was bulbar cranial nerves affection (without fascial palsy), right side
hypotonia, power grade 3 and hyporeflexia. The patient was sent for
urgent brain CT scan which showed left parietal area infarction. See