Leaking heart: Ticking time bomb!

Abstract

Context:Cardiac rupture is a very important but under-recognized complication of acute myocardial infarction and usually happens within a week of the event. Sometimes it can be subacute and may not be typical of an acute blow out rupture. Hence careful evaluation is needed as a missed or delayed diagnosis can be fatal. An emergent echocardiogram may aid in immediate diagnosis. Surgery is the only treatment option and is mandatory despite the high mortality risk.Case Report:An elderly male presented with dizziness and hypotension. Based on the timeline of his symptomatology, electrocardiographic abnormalities and labs, a subacute cardiac rupture was suspected in the emergency room itself. A high index of suspicion is needed to diagnose cardiac rupture.Conclusion:Subacute cases can be missed easily as presentation may not be dramatic. They can rapidly progress to a blowout rupture increasing mortality risk heavily even with surgical treatment.

“Swiss-Cheese” Left Ventricle in Acute Myocardial Infarction—A Case Report

“…The free wall rupture in acute ST-elevation myocardial infarction is under-recognized [62] and sometimes it is subacute, may not be typical of an acute blowout rupture and leading to death within minutes. Instant diagnosis is crucial to detect free wall ruptures by transthoracic echocardiography.…”

Appropriate Surgical Repair of Ventricular Free Wall Rupture after Infarction: a Case Report

“…However, the median time for diagnosis is typically four months after the infarct. Symptoms and signs of acute ruptures are typically presenting as chest pain, syncope, cyanosis, hypotension, bradycardia, pulsus paradoxus, elevated venous pressures, very feeble heart sounds, electromechanical dissociation and cardiogenic shock [3] . Pseudoaneurysm in subacute clinical manifestations can be diagnosed as incidental because it has not specific clinical findings.…”

Post‐MI free wall rupture syndrome. Case report, literature review, and new terminology

“…As an important and rare complication of acute ST‐segment elevation myocardial infarction (STEMI), free wall rupture is under‐recognized . Sometimes it can be subacute and may not be typical of an acute blowout rupture leading to death in few minutes . We recently encountered three patients with subacute free wall rupture after STEMI.…”