Early Detection of Free Wall Rupture by Point of Care Ultrasound

Abstract

Free wall ruptured is a rare but fatal complication of post myocardial infarction (MI). Point-of-care ultrasound provides a rapid diagnosis and increase chances of patient’s survival. Case report and literature review. A 49-year-old man with past history of type A dissection status post grafting operation and hypertension under regular medication control; He visited our Emergency Department with complaint of sudden onset chest pain that radiates to back for a day with hypotension. Electrocardiogram revealed ST elevation over anteriolateral leads (V2-V4). Point-of-care ultrasound shows free wall rupture of lateral wall with pericardial effusion. Computed tomogram angiography also revealed hemopericardium and free wall rupture. Patient received emergent vascular exposure for extracorporeal membrane oxygenation removal and vessel repair operation and recovery has been uneventful and is discharged under stable condition. Free wall rupture is a deathly complication of post cardiac infarction; incidence rate of approximately 2-4% and 12–21% of deaths following MI. Complication typically does not occur within 24 hours of post MI but at the highest incidence of the following 7 days. Mortality is extremely high; hence, early finding is essential. The definite diagnostic criterion is echocardiography, with sensitivity of 100% and a specificity of 93%. The actual tear site, hemopericardium and right-heart collapse can be seen through echocardiography. Free wall rupture is a critical complication of post MI, requires rapid diagnosis and operation treatment. Point-of-care ultrasound provides an effortless and ultimate diagnosis, thus, increases the chance of survival.