MULTIPLE EMBOLIC EVENTS LEADING TO DEATH AFTER STEMI: A CLINICAL CASCADE

Left ventricular thrombus (LVT) is a recognized complication of acute myocardial infarction (AMI) and carries a high risk of systemic embolization. We report the case of a 72-year-old woman with poorly controlled hypertension who presented 28 hours after onset of anterior ST-segment elevation myocardial infarction (STEMI). Transthoracic echocardiography revealed a large apical thrombus measuring 36 × 21 mm. Despite immediate dual antiplatelet therapy and therapeutic-dose anticoagulation, she developed an acute ischemic stroke within one hour, followed by bilateral lower-limb ischemia caused by complete infrarenal aortic thrombosis. Emergent surgical thrombectomy was attempted, but the patient suffered cardiac arrest and could not be resuscitated. This case highlights the exceptional embolic risk of large, mobile LVT and underscores the need for early recognition, vigilant monitoring, and aggressive management strategies in high-risk patients.