ACADM and heart failure: In a seven-year-old female with MELAS due to the variant m.3243A>G in tRNA(Leu) (heteroplasmy 58%) and the variant c.985A>G in medium-chain acyl-CoA dehydrogenase (MCAD), MRA revealed occlusion of the left ICA in the absence of atrial fibrillation and heart failure or any classical risk factor for ASCL [5].