PMC5637824_01
(a) Head CT at time of admission showing no acute findings. (b) Subsequent head CT showing acute multiembolic stroke (arrows).
CRIC2017-9072523.001.jpg
PMC5637824_01_CRIC2017-9072523.001.jpg
fig1
IV diuretics were started. Initial head computed tomography (CT) scan showed no new or acute processes (Figure 1(a)). Interrogation of the patient's implantable cardioverter defibrillator revealed no evidence for significant arrhythmias. A repeat head CT scan revealed multiple acute embolic infarcts in the bilateral posterior temporal lobes, left occipital lobe, and posterior right middle cerebral artery involving the parietal and temporal lobes (Figure 1(b)).
Ramp study analysis showing LVEDD slope of -0.05. An LVEDD slope >= -0.16 is consistent with flow obstruction due to pump thrombosis. LVEDD = left ventricular end-diastolic dimension. RPM = revolutions per minute.
CRIC2017-9072523.002.jpg
PMC5637824_01_CRIC2017-9072523.002.jpg
fig2
From a baseline LVAD speed of 9000 rpm, echocardiogram images were then obtained in stepwise increments from 8600 rpm to 12000 rpm (Figure 2).