Severe Ischemic Cardiomyopathy in a Young Smoker: A Rare Case of Apical Thrombus and Ventricular Tachycardia

Introduction: Ischemic cardiomyopathy, though rare in young adults, can lead to severe complications such as left ventricular dysfunction, intracardiac thrombi, and arrhythmias. This case highlights the significance of early recognition and management strategies in preventing life-threatening outcomes in young patients with ischemic heart disease.

Case Presentation: We present the case of a 36-year-old male smoker who presented with acute dyspnea and palpitations. Clinical evaluation revealed severe left ventricular dysfunction (ejection fraction 20%), an apical thrombus (1.5 cm), and sustained ventricular tachycardia, successfully terminated with lidocaine and amiodarone. Coronary angiography showed tortuosity of the left anterior descending artery (LAD) without significant stenosis. The patient was treated with anticoagulation and optimized heart failure therapy, including angiotensin-converting enzyme (ACE) inhibitors and beta-blockers.

Conclusion: This case underscores the complexity of ischemic cardiomyopathy in young smokers. A comprehensive, multidisciplinary approach, including early detection, anticoagulation, antiarrhythmic therapy, and heart failure management, is crucial for improving outcomes in these patients.