IJCS | Volume 32, Nº2, May/June 2019

295 Figure 2 - Magnetic resonance imaging showing increased trabeculations. RV: right ventricle; LV: left ventricle; LA: left atrium. LV RV LA Increase in trabeculations Nascimento et al. Extrasystoles in non-compacted myocardium Int J Cardiovasc Sci. 2019;32(3)293-296 Case Report which communicate with the ventricular cavity due to non-compaction. 2 Without the compaction completion, myocardial dysfunction occurs secondary to the failure of the efficient rotational ventricular system to develop contractile performance. 5 The exact causeof thepersistenceof these trabeculations is unknown. 1-3 Studies point to familial recurrence of LV non-compacted myocardium. 1,4 The clinical status is variable, and it may be asymptomatic or present as heart failure, arrhythmias, thromboembolic events and sudden death. 2-4,6 In the present report, the patient had ventricular arrhythmia and systolic heart failure as initial manifestations – found in more than 50% of the cases. 2-4,6 Ventricular arrhythmias were reported in 47% of adults. 2 Diastolic dysfunction occurs due to abnormal ventricular relaxation and restrictive filling caused by hypertrabeculation, whereas systolic dysfunction may result from subendocardial hypoperfusion and microcirculatorydysfunction. 2,6 Mechanical dyssynchrony between the compacted and non-compactedmyocardium may cause global LV dysfunction. 2 Other rhythm abnormalities were also reported on the electrocardiogram, such as ST-segment depression and T-wave inversion, alongwith right-bundle branchblock. 2,4,6 In view of the diagnosis of LV systolic dysfunction associated with non-compacted myocardium, full anticoagulation therapy with warfarin was initiated. Associated thromboembolic events may be secondary to extensive ventricular trabeculation, atrial fibrillation, and decreased ventricular function, 2,3 which may lead to cerebrovascular accidents, transient ischemic attacks, pulmonary embolism, and mesenteric infarction. 2,6 Sudden death represents approximately 40% of cases of death in these patients. 2 In the present clinical case report, the patient was asymptomatic. The findings of ventricular extrasystoles were incidentally found during a preoperative examination. The alterations foundon the echocardiogram showed heart failure with reduced ejection fraction and