Is follow-up echocardiogram mandatory after a STEMI?

SUMMARY: Current guidelines do not advise follow-up echocardiograms after ST-segment elevation myocardial infarction (STEMI), unless the left ventricular ejection fraction is ≤40%. We present an interesting case of left ventricular pseudo-aneurysm – diagnosed 6 months after index STEMI presentation. Follow-up echocardiogram was performed in her case, due to jaw pain during routine haemodialysis. The patient was successfully treated with percutaneous closure device. This case raises the question of whether echo follow-up should be routinely advised after STEMI – even in those with minimal cardiac symptoms. LEARNING POINTS: Patients with left ventricular pseudo-aneurysm can be haemodynamically stable and may not always be in extremis. Left ventricular pseudo-aneurysm can develop months after ST elevation myocardial infarction. In patients re-presenting with cardiac symptoms after ST elevation myocardial infarction, a repeat echocardiogram should be considered. In patients suffering ST elevation myocardial infarction, it is reasonable to consider repeat echocardiography even with mild LV dysfunction, especially with late presentation or disproportionately high biomarkers.