Catastrophic Event Following Percutaneus Coronary Intervention Developing In-Stent Thrombosis Leading Massive Pericardial Effusion and Free Wall Rupture

Abstract

BACKGROUND: One extremely unusual but serious side effect of an acute myocardial infarction is left ventricular free wall rupture. It was reported to happen either during the sub-acute phase with overt cardiac remodeling (type III, 45%) or early after the beginning of Myocardial Infarction (MI) (type I or II, about 55%). Large infarct sizes, female gender, and advanced age have all been linked to an increased risk of free wall rupture. Clinicians continue to face significant challenges in diagnosing and treating this condition because of the diverse clinical manifestations linked to elevated death rates. AIMS: This case report aims to highlight a rare occurrence of mechanical complication of acute myocardial infarction CASE: A 69-year-old male patient was referred because of chest pain and dyspneu. He had a primary Percutaneous Coronary Intervention (PCI) and was diagnosed with posterior ST-Evelation Myocardial Infarction (STEMI). The patient had a stent inserted into his ostial-distal Left Circumflex (LCx) artery. Three weeks later, a reangiography revealed a left ventricle (LV) aneurysm and stent thrombosis. Massive pericardial effusion with free wall rupture was seen on the echo. He was breathing heavily while in our emergency room. His blood pressure was 125/74 (94) heart rate was 94 bpm respiratory rate 24 times/minute, SpO2 was 98%, there were no rales, and his ankles had pitting edema. By the bedside, Echo revealed an LV aneurysm, a large, localized pericardial effusion without tamponade, and a possible free wall rupture. Later, he was taken to the intensive care unit and had heart surgery DISCUSSION: Complications from an acute myocardial infarction may be ischemic, mechanical, arrhythmic, embolic, or inflammatory. Significant short-term clinical improvement and long-term survival are linked to the emergence of mechanical problems following acute myocardial infarction. CONCLUSION: the fact that primary Percutaneous Coronary Intervention (PCI) has significantly reduced the prevalence of this deadly event. Our results indicate that one of the key predictors and primary causes of this problem is a longer symptom of angiography time.