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.
