Abstract
There are three major mechanical complications of acute myocardial infarction: rupture of the left ventricular free wall, rupture of the interventricular septum, and development of mitral regurgitation. Each of these complications is associated with extremely high mortality. Reviewing the scientific literature, we found descriptions of sporadic cases of both of those complications combined. We report an unusual case of simultaneous rupture of free wall and interventricular septum.
Highlights
CASE REPORTThe 80-year-old female patient (pt) was brought to the Emergency Department unconscious
There are three major mechanical complications of acute myocardial infarction: rupture of the left ventricular free wall, rupture of the interventricular septum, and development of mitral regurgitation
We report an unusual case of simultaneous rupture of free wall and interventricular septum
Summary
The 80-year-old female patient (pt) was brought to the Emergency Department unconscious Her medical history was remarkable for cerebrovascular accident (CVA) two years ago with residual motor aphasia and left hemiparesis. Bedside echocardiography (echo) revealed severe right and moderate left ventricular dysfunction due to inferopostero-lateral akinesia, mild-moderate aortic regurgitation (AR), and large pericardial effusion with thrombus (Figure 1). Due to lack of response to massive fluid infusion, intravenous Dopamine and Dobutamine were administered Her condition improved gradually and the patient was weaned from mechanical ventilation. Repeat 2D echo demonstrated left to right shunting through the interventricular septum (Figure 2). Heart surgery was again rejected in favor of a medical approach.
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