Free Wall Rupture: The Fatal Complication not to Forget

Abstract

Learning Objective: Following a non-revascularized myocardial infarction, a rare complication can occur: free wall rupture. It's important to keep an eye out for this diagnosis when concomitant pericardial effusion is present, even if the patient appears stable initially. We stress the significance of utilizing systematic echocardiography to make a definitive diagnosis. Case Presentation: A man who had numerous cardiovascular risk factors was admitted with delayed inferior ST-segment elevation myocardial infarction at the age of 65. Upon the performance of bed side echocardiography, it was discovered that he had a rupture of the left ventricular wall with pericardial effusion. The patient's condition deteriorated two hours after admission, leading to his manifesting severe dyspnea and hypotension. After undergoing CPR for 20 minutes, the patient was intubated and resuscitated; he was then rapidly transported to the operating room for immediate exploration. Tragically, the patient suffered another cardiac arrest while in the operating room, and after another hour of resuscitation efforts, he passed away on the table. Conclusion: Acute and sub acute types of ventricular free wall rupture are both rare, but their impact following myocardial infarction can be catastrophic. Tragically, this phenomenon is the second leading contributor to death in cases of acute myocardial infarct. Although different types of rupture exist, the prognosis is consistently unfavorable.