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

Abstract

Background. Left ventricular free wall rupture is a mechanical complication that can occur on the 5th to 14th day after AMI with an incidence of 2-4% and a mortality of 20%. The most common ruptures are the posterior inferolateral free wall (43%), the lateral wall (28%) and in rare cases the apical wall (24%). Objective(s). Presentation of the clinical case of a male patient with typical symptoms of acute myocardial infarction and an electrocardiographic pattern of left ventricular aneurysm. Materials and methods. 73-year-old non-smoker man, without a history of cardiovascular pathologies, with type 2 diabetes mellitus, worsening condition on the 14th day from onset with the recurrence of anginal syndrome: prolonged precordial pain of a constricting nature, dyspnea and physical asthenia. Investigations performed: ECG, EcoECG, AngioCT, TroponinT. Results. Electrocardiogram- 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 of the left ventricular free wall 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). Left ventricular free wall rupture is a rare complication, but with a poor prognosis and high mortality rate. Precipitating risk factors were age > 70 years, diabetes mellitus, lack of percutaneous coronary intervention after acute myocardial infarction.