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 are: age > 70 years, diabetes mellitus, lack of
percutaneous coronary intervention after acute myocardial infarction.
