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Management strategies Key points
• Acute management included brain
magnetic resonance imaging and
computed tomography to evaluate the
presumptive transient ischemic attack;
empiric anticoagulation was initiated,
as intracerebral hemorrhage and other
contraindications were absent.
• CMR and EP testing with programmed
ventricular stimulation were performed
to assess myocardial involvement and
conduction system disease, and to
determine ventricular arrhythmic risk.
The patient may be a candidate for a
primary prevention ICD with pacing
capability, if significant conduction
disease or VAs are observed.
• Because the patient was young
and otherwise functional with
presumptive transient ischemic
attack, long-term management
included anticoagulation, in the
absence of contraindications, with
periodic assessment of left ventricular
function and surveillance for brady- or
tachyarrhythmias.
• EDMD is associated with chamber
dilation, especially atrial.
• AF and atrial standstill with an increased
risk of thromboembolic complications
including stroke in EDMD are well
known.
• Low-normal LVEF with AV valve
incompetence may reflect mild left
ventricular dysfunction in this context.
• A directed assessment of arrhythmic risk
is warranted in this patient population
based on presenting symptoms, physical
findings, and clinical index of suspicion
for serious rhythm disturbances.
