Left ventricular free wall rupture - the most severe complication of acute myocardial infarction

Abstract

Introduction. Left ventricular free wall rupture is a mechanical complication that can occur on the 5th-14th day post-AMI with an incidence of 2-4% and a mortality of 20%. The most common rupture is the posterior inferolateral free wall (43%), the lateral wall 28%) and the apical wall (24%). Purpose of the paper: Presentation of the clinical case of a patient with typical symptoms of acute myocardial infarction with the ECG pattern of LV aneurysm. Materials and methods. 73-year-old non-smoker man, with no history of documented cardiovascular pathologies, with type 2 diabetes mellitus with oral antidiabetic treatment. Typical anginal pains began a week ago, but he did not consult a doctor because they had decreased in intensity. The condition worsened for one day with the reappearance of anginal syndrome: prolonged precordial pains with a constricting character, dyspnea and marked physical asthenia. Investigations: electrocardiogram, echocardiography, Angio CT, Troponin-T. Results. ECG: sinus rhythm, FCC 100 c/min, horizontal AEC, QS and residual ST segment elevation in leads V1-V6. Echocardiography: Apical SIV endocardial dissection and LV apex with myocardial thinning up to 4 mm with rupture and hematoma formation in the pericardium at the apex, moderate pericardial effusion, AngioCT: LAD II and LAD III occlusion, severe stenoses on RCA I-II, aCX I, IR. Pericardial hematoma in the apex projection. Troponin-T- 0.01ng/ml. The patient opted for a conservative treatment strategy, was discharged on the 24th day in stable general condition. Conclusion(s). LV free wall rupture is a rare complication, but with a poor prognosis and high mortality rate. Precipitating risk factors are age >70 years, diabetes mellitus, lack of PCI after AMI.