After LVAD implantation, a patient presents with sudden onset of slurred speech and unilateral weakness. Which complication is most likely?

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

Answer: (A)

A cerebrovascular event is the most likely explanation here. Sudden slurred speech with unilateral weakness points to a focal brain deficit from a stroke. In LVAD patients, stroke is a known complication because blood contact with artificial surfaces and altered flow can promote thrombus formation and embolization, even with anticoagulation. An embolus traveling to cerebral vessels can quickly produce dysarthria and hemiparesis as it disrupts blood flow to a brain territory. The other options don’t fit this acute focal presentation: right heart failure would cause systemic congestion and signs like edema or hepatomegaly; depression wouldn’t cause sudden unilateral weakness; device failure or death would present with pump dysfunction or systemic instability rather than a new neuro deficit.