Free-Wall Rupture Post–Reperfused Acute Myocardial Infarction

Abstract

A 37-year-old man presented with acute inferior ST-segment–elevation myocardial infarction (MI). His only risk factor for coronary artery disease was smoking. He underwent urgent x-ray coronary angiography, which showed a chronically occluded left anterior descending artery and recannulized right coronary artery. A bedside echocardiogram was performed to assess left ventricular function and any postinfarct complications. It demonstrated severely impaired left ventricular systolic function and an aneurysmal apex with a mobile intracavity mass (Figure 1A and 1B, online-only Data Supplement Movies I and II). Further views demonstrated hemopericardium suggesting concealed free-wall rupture (Figure 1B, purple arrow). An intramyocardial tear at the level of the midinferior wall (Figure 1B, red arrow) was suspected. Figure 1. A and B , Echocardiogram demonstrating a hemopericardium located posteriorly to the inferior wall (purple arrow) and intramyocardial dissection …