SHM Converge Scientific Abstract ePoster Gallery-The Silent Divide: A Rare Case of Cor Triatriatum Sinister Presenting as Embolic Stroke

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A 47-year-old man with heart failure with reduced ejection fraction, hypertension, and poorly controlled type 2 diabetes presented with transient left-sided weakness, headache, and numbness, concerning for stroke. On arrival, he was markedly hypertensive and hyperglycemic, and ECG showed atrial fibrillation. Brain MRI revealed multifocal acute infarcts in an embolic pattern. <br /><br />Cardiac workup showed a severely dilated left atrium with a fibromuscular ridge on transthoracic echocardiogram. Cardiac MRI confirmed cor triatriatum sinister (CTS), a rare congenital anomaly in which a membrane divides the left atrium into two chambers. The MRI also showed asymmetric severe septal hypertrophy with late gadolinium enhancement, raising concern for hypertrophic cardiomyopathy (HCM). <br /><br />CTS is uncommon, representing up to 0.4% of congenital heart defects, and is often diagnosed in childhood. However, it may remain silent until adulthood and present through complications such as atrial fibrillation, heart failure, or embolic stroke. In this case, the combination of CTS, atrial fibrillation, and possible HCM likely contributed to thromboembolic risk. <br /><br />The patient was started on apixaban and discharged with a wearable external defibrillator. He was also referred for outpatient electrophysiology and congenital cardiology follow-up. This case highlights the importance of considering rare structural heart disease in adults presenting with embolic stroke and atrial fibrillation, and the need for timely specialist evaluation to reduce the risk of recurrence.

Asset Subtitle

Robert DeStefano

Meta Tag

Author List Dimitri Ford, Robert DeStefano, Shenieka Bennett

Category Clinical Vignettes

Concept Cor Triatriatum Sinister

Concept Hypertrophic Cardiomyopathy

Concept Congenital Left Atrial Anomaly

Concept Atrial Fibrillation

Concept Embolic Stroke

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine, Division of Hospital Medicine

Presenting Author Robert DeStefano

Track Adult

Keywords

cor triatriatum sinister

atrial fibrillation

embolic stroke

left atrial anomaly

hypertrophic cardiomyopathy

heart failure with reduced ejection fraction

multifocal acute infarcts

cardiac MRI

thromboembolic risk

congenital heart disease

Cor Triatriatum Sinister

Hypertrophic Cardiomyopathy

Congenital Left Atrial Anomaly

Atrial Fibrillation

Embolic Stroke