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Heart, Lung and Circulation (2014) xx, 1–2 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2014.03.006
Fatal Left Ventricular Free Wall Rupture following Acute Myocardial Infarction Sang-Hoon Seol *, Guang-Won Seo, Dong-Kie Kim, Song-Pil Sang, Ki-Hun Kim, Doo-Il Kim Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik hospital, Busan, Korea Received 3 December 2013; accepted 2 March 2014; online published-ahead-of-print xxx
A 67 year-old woman who had no specific history presented in the emergency room with complaints of sudden chest pain, vomiting and syncope. The patient was conscious and physical examination showed heart rate 52 beats/min, blood pressure 60/30 mm Hg, temperature 36.5˚C. Heart sound was faint. Electrocardiogram showed ST elevation at II, III, aVF and sinus bradycardia (Fig. 1). Chest X-ray revealed pulmonary oedema (Fig. 2). The levels of CK-MB (30.3 ng/nL), troponin I(9.8 ng/mL) and Pro-BNP 2399 pg/mL were elevated.
Transthoracic echocardiography revealed basal inferior wall rupture of left ventricle. Defect size was 2.27 cm. There were no regional wall motional abnormalities except basal inferior wall (Fig. 3). The patient‘s condition progressively worsened and took a rapid downhill course, despite aggressive haemodynamic support. Finally the patient died. Cardiac rupture is one of the serious complications of acute myocardial infarction. Chest pain, bradycardia, unexplained emesis, and syncope may be signs of cardiac rupture [1,2].
Figure 1 Electrocardigram showed ST segment elevation in lead II, II aVF.
*Corresponding author at: Department of Medicine, Inje University College of Medicine, Haundae Paik Hospital, 1435 Jwa-dong, Haeundae-gu, Busan, 612-030, Korea. Tel.: +82 51 797 3070; fax: +82 51 797-3009., Email: [email protected] © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
Please cite this article in press as: SeolS-H, et al. Fatal Left Ventricular Free Wall Rupture following Acute Myocardial Infarction. Heart, Lung and Circulation (2014), http://dx.doi.org/10.1016/j.hlc.2014.03.006
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Figure 2 Chest X-ray revealed pulmonary edema.
Figure 3 A and B: There was the rupture of left ventricular inferior wall at apical 2 chamber view (arrow). C: Ruptured myocardial wall could be seen at short axis view (arrow). D: Diastolic phase of apical four chamber view did not showed the defect of myocardial free wall.
References [1] Wehrens XH, Doevendans PA, Widdershoven JW, et al. Usefulness of sinus tachycardia and ST-segment elevation in V(5) to identify impending left ventricular free wall rupture in inferior wall myocardial infarction. Am J Cardiol 2001;88:414–7.
[2] Pappas PJ, Cernaianu AC, Baldino WA, Cilley Jr JH, DelRossi AJ. Ventricular free-wall rupture after myocardial infarction. Treatment and outcome. Chest 1991;99:892–5.
Please cite this article in press as: SeolS-H, et al. Fatal Left Ventricular Free Wall Rupture following Acute Myocardial Infarction. Heart, Lung and Circulation (2014), http://dx.doi.org/10.1016/j.hlc.2014.03.006
IMAGE
Heart, Lung and Circulation (2014) xx, 1–2 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2014.03.006
Fatal Left Ventricular Free Wall Rupture following Acute Myocardial Infarction Sang-Hoon Seol *, Guang-Won Seo, Dong-Kie Kim, Song-Pil Sang, Ki-Hun Kim, Doo-Il Kim Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik hospital, Busan, Korea Received 3 December 2013; accepted 2 March 2014; online published-ahead-of-print xxx
A 67 year-old woman who had no specific history presented in the emergency room with complaints of sudden chest pain, vomiting and syncope. The patient was conscious and physical examination showed heart rate 52 beats/min, blood pressure 60/30 mm Hg, temperature 36.5˚C. Heart sound was faint. Electrocardiogram showed ST elevation at II, III, aVF and sinus bradycardia (Fig. 1). Chest X-ray revealed pulmonary oedema (Fig. 2). The levels of CK-MB (30.3 ng/nL), troponin I(9.8 ng/mL) and Pro-BNP 2399 pg/mL were elevated.
Transthoracic echocardiography revealed basal inferior wall rupture of left ventricle. Defect size was 2.27 cm. There were no regional wall motional abnormalities except basal inferior wall (Fig. 3). The patient‘s condition progressively worsened and took a rapid downhill course, despite aggressive haemodynamic support. Finally the patient died. Cardiac rupture is one of the serious complications of acute myocardial infarction. Chest pain, bradycardia, unexplained emesis, and syncope may be signs of cardiac rupture [1,2].
Figure 1 Electrocardigram showed ST segment elevation in lead II, II aVF.
*Corresponding author at: Department of Medicine, Inje University College of Medicine, Haundae Paik Hospital, 1435 Jwa-dong, Haeundae-gu, Busan, 612-030, Korea. Tel.: +82 51 797 3070; fax: +82 51 797-3009., Email: [email protected] © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
Please cite this article in press as: SeolS-H, et al. Fatal Left Ventricular Free Wall Rupture following Acute Myocardial Infarction. Heart, Lung and Circulation (2014), http://dx.doi.org/10.1016/j.hlc.2014.03.006
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S-H Seol et al.
Figure 2 Chest X-ray revealed pulmonary edema.
Figure 3 A and B: There was the rupture of left ventricular inferior wall at apical 2 chamber view (arrow). C: Ruptured myocardial wall could be seen at short axis view (arrow). D: Diastolic phase of apical four chamber view did not showed the defect of myocardial free wall.
References [1] Wehrens XH, Doevendans PA, Widdershoven JW, et al. Usefulness of sinus tachycardia and ST-segment elevation in V(5) to identify impending left ventricular free wall rupture in inferior wall myocardial infarction. Am J Cardiol 2001;88:414–7.
[2] Pappas PJ, Cernaianu AC, Baldino WA, Cilley Jr JH, DelRossi AJ. Ventricular free-wall rupture after myocardial infarction. Treatment and outcome. Chest 1991;99:892–5.
Please cite this article in press as: SeolS-H, et al. Fatal Left Ventricular Free Wall Rupture following Acute Myocardial Infarction. Heart, Lung and Circulation (2014), http://dx.doi.org/10.1016/j.hlc.2014.03.006
