A patient with LVAD presents with facial droop and slurred speech; neurologic deficits suggest a cerebrovascular event. Which complication?

• A. Stroke
• B. RH failure
• C. Depression
• D. Device failure/death

Answer: (A)

The key idea is that new focal neurologic deficits in an LVAD recipient point to a cerebrovascular event. LVADs increase the risk of stroke because the pump and its flow can generate thrombi that embolize to cerebral vessels, and patients require anticoagulation, which reflects the balance between preventing thrombosis and avoiding bleeding. Facial droop and slurred speech localize to a brain area supplied by a major artery, making ischemic or hemorrhagic stroke the most likely complication in this scenario. This presentation is not typical for right heart failure, which causes systemic congestion and organ hypoperfusion without focal brain signs, nor for depression, which is a mood disorder and would not explain acute unilateral neurologic findings. Device failure or death would present with device alarms or catastrophic hemodynamic collapse rather than new focal neurologic symptoms.