Subacute left ventricle free wall rupture after acute myocardial infarction: awareness of the clinical signs and early use of echocardiography may be life-saving

Abstract

Left ventricular free wall rupture (LVFWR) is a fearful complication of acute myocardial infarction in which a swift diagnosis and emergency surgery can be crucial for successful treatment. Because a significant number of cases occur subacutely, clinicians should be aware of the risk factors, clinical features and diagnostic criteria of this complication. We report the case of a 69 year-old man in whom a subacute left ventricular free wall rupture (LVFWR) was diagnosed 7 days after an inferior myocardial infarction with late reperfusion therapy. An asymptomatic 3 to 5 mm saddle-shaped ST-segment elevation in anterior and lateral leads, detected on a routine ECG, led to an urgent bedside echocardiogram which showed basal inferior-wall akinesis, a small echodense pericardial effusion and a canalicular tract from endo to pericardium, along the interface between the necrotic and normal contracting myocardium, trough which power-Doppler examination suggested blood crossing the myocardial wall. A cardiac MRI further reinforced the possibility of contained LVFWR and a surgical procedure was undertaken, confirming the diagnosis and allowing the successful repair of the myocardial tear. This case illustrates that subacute LVFWR provides an opportunity for intervention. Recognition of the diversity of presentation and prompt use of echocardiography may be life-saving.

Successful surgical repair of a chronic left ventricular pseudoaneurysm

“…A number of factors predispose to this complication, including elderly age, female sex, arterial hypertension, anterior wall infarction, fibrinolytic treatment, lack of previous coronary episodes, as well as the administration of steroids and non-steroidal anti-inflammatory medications during the acute phase of the infarction. The aneurysm usually develops between the 1 st and the 21 st day, most frequently on the 5 th to 7 th day of the infarction [3].…”

An Echo-Dense Cap in the Pericardial Space After Acute Myocardial Infarction: A Case Report

“…In both methods, the suture line should be along the nonischemic myocardium and transmural stitches are needed (4,(7)(8)(9).…”

Global ST-Segment Elevation Associated With Impending Cardiac Rupture During Diagnostic Cardiac Catheterization

“…New STsegment elevation is one of the ECG changes to suspect cardiac rupture complicating acute myocardial infarction. 8) Cardiologists must be aware that global STsegment elevation during cardiac catheterization is a sign of impending cardiac rupture even in a patient without acute myocardial infarction. In the present case, transthoracic echocardiography immediately after the development of STsegment elevation showed no pericardial effusion.…”