Abstract:
The rupture of the ventricular wall complicates 1- 3% of the patients suffering from acute
myocardial infarction. On necroptic studies the percentage raises up to 7-24%. The risk factors are
age>60 years, feminine gender and hypertension. The acute ruptures are characterized by shock
through cardiac tamponade. The subacute ruptures are a challenge for surgeons; immediate
postoperatory death varies between 0 to 60%. Death without surgery occurs in 100% of the cases. A
73 years old male patient is admitted to the hospital for intermittent claudication at 15-20m, with
insignificant heredocolaterale history, smoker for approximately 60 years 1 package per day. The
patient has no cardiological history. After his admission he presented syncope. The clinical exam showed turgescent jugular veins, diffuse abdominal pain, and the lower liver margin was palpable 2
cm under the right costal margin. Differential diagnosis was: mesenteric ischemia, cardiac tamponade
and aortic dissection. The transtoracic echocardiography showed the presence of pericardial liquid of
25 mm in the right ventricle, an intrapericardial thrombus in the left ventricle. The final diagnosis is
acute anteroapical myocardial infarction with cardiac rupture, intrapericardial thrombus, pericardial
tamponade and obliterant arteriopathy of the inferior limbs, stage III. The patient was transferred to
the Cardiology Center in Iasi and after the necessary investigations went directly to the operating
room due to the mechanical complication of the infarction. The postoperatory evolution was good.
The particularities of the case consist of: the sudden debut through the rupture of the myocardium
without the typical retrosteral pain; the lack of EKG or the necrosis enzymes modifications and the
good postoperatory evolution.
