Posterior Wall Myocardial Infarction Research Articles

Acute Occlusion of a “Protected” Left Main Coronary Artery Manifesting as an Acute Coronary Syndrome with Heart Failure: How much Protected it is?

Despite the progress made in technological advancements, the utilization of stenting for both protected and unprotected left main coronary artery (LMCA) disease remains associated with elevated rates of long-term mortality and significant adverse clinical events, sometimes manifesting as cardiogenic shock. A considerable number of individuals retain the opportunity to receive catheter-based interventional therapy as a viable substitute for re-operative coronary artery bypass grafting (CABG). Despite the changed appearance, patients with acute blockage of the protected LMCA still have major adverse cardiac events (MACE) at a similar rate. Acute occlusion of the unprotected LMCA as an acute coronary syndrome (ACS) is uncommon, but that of the protected LMCA is relatively rare. We present a case of a post-CABG patient who developed ACS as a posterior wall myocardial infarction and acute left ventricular failure due to obstruction of a protected LMCA with substantial stenosis across its distal segment extending to the left circumflex (LCx) artery. The pharmaco-invasive management of the protected LMCA thrombotic occlusion with primary percutaneous coronary intervention resulted in significant patient improvement. These lesions are amenable to complex and high-risk coronary intervention with current technology, and the results have been quite encouraging in terms of long-term survival.

Incidence of ventricular tachyarrhythmias and clinical outcomes in primary prophylactic ICD patients in relation to localization of myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction According to current guidelines, primary prophylactic ICD implantation is indicated with a class IA recommendation in patients with severely reduced EF < 35% and ischaemic heart disease. However, it is unclear whether there are differences in patient outcomes related to the localization of myocardial infarction. Aim of the study was to compare the incidence of ventricular tachyarrhythmias and clinical outcomes in primary prophylactic ICD-patients with ischaemic heart disease in relation to the localization of myocardial infarction. Methods A total of 448 consecutive ICD patients from a prospective single-centre ICD-registry who underwent primary prophylactic ICD implantation due to ischaemic cardiomyopathy between 1996 and 2021 were analyzed. Patients with previous anterior wall myocardial infarction (AWMI, n = 293) were compared to those with posterior wall myocardial infarction (PWMI, n = 155). Patients with both AWMI and PWMI were excluded. The median follow-up time was 6 years in both groups. Results Patients with AMWI were younger, more often female, and less often received cardiac synchronization therapy (Table 1). Patients with previous PWMI more often had ICD therapy during follow-up (Figure 1) due to the higher incidence of ventricular tachycardias (Table 1). The all-cause mortality rate was similar between both groups. Conclusion Primary prophylactic ICD patients with previous PWMI have a 10% higher incidence of ventricular tachycardias after 6-year follow-up than ICD patients with previous AMWI. This might be explained by the proximity of the inferior infarction to the mitral isthmus and should be considered when ablating VTs in patients with PWMI.

Relevant anatomy of epicardial space for the electrophysiologists

The arrhythmogenic substrate in patients with Chagas cardiomyopathy, arrhythmogenic dysplasia, postmyocarditis nonischemic dilative cardiomyopathy as well as after extensive posterior or anterior wall myocardial infarction is predominantly located epicardially. This can necessitate epicardial access for an effective, substrate-based catheter ablation of the ventricular tachycardia (VT). Anterior percutaneous epicardial puncture represents the standard approach for epicardial VT ablation. The most important anatomical particularities that must be taken into account when performing an epicardial puncture or epicardial VT ablation are epicardial coronary arteries, left phrenic nerve and epicardial fat. The typical anatomic characteristics of the epicardial structures and resulting considerations for epicardial access are discussed here in detail.

Murder and Culpable Homicide versus Trauma and Disease: A Case-Based Forensic Pathological Review from the Perspectives of Penal Law in Selected South/South-East Asian Jurisdictions

The cause of death was given as acute posterior wall myocardial infarction due to right coronary artery atherosclerosis following a death of a previously healthy, chronic smoker who was found dead following a brief altercation. It was commented that “There were non-fatal, non-grievous injuries and in a setting of acute myocardial infarction and chronic ischemia with fatty metamorphosis, the stress induced by the said altercation could have led to an arrhythmic status causing sudden death”. The prima-facie question arising from a trial of such a case is the degree of culpability, namely (1) whether the alleged assailant has caused the death of the deceased? (2) If so, whether he/she qualify for the charge of (2a) culpable homicide not amounting to murder, (2b) culpable homicide amounting to murder or (2c) compete exoneration. This review discusses said vexing questions in a context of the penal law of the said jurisdictions.

Percutaneous Coronary Intervention in an Octogenarian With Anomalous Origin Arising From Right Sinus: A Rare Case Report

Anomalous coronary artery origins are not common in routine clinical practice. The incidence of coronary anomalies in patients undergoing coronary angiography is less than 1%. The greatest challenges faced in the management are delays in identification and difficulty engaging the anomalous coronary artery. Operator experience in promptly identifying the anomaly and selection of the appropriate catheter is critical for successful intervention. We are presenting a case of acute inferior and posterior wall myocardial infarction (MI) with an anomalous origin of the left circumflex artery from the right coronary sinus. Learning objective is that percutaneous coronary intervention (PCI) in an anomalous left circumflex can be technically difficult because selective cannulation of the vessel may not be easy. An anomalous left circumflex artery has a rare presentation of ST-elevation myocardial infarction (STEMI). Complicated STEMI with cardiogenic shock is not commonly seen in anomalous coronary artery origin from the right sinus. Percutaneous intervention in patients with STEMI with an anomalous left circumflex artery has a high risk and is technically challenging. J Med Cases. 2020;11(2):41-43 doi: https://doi.org/10.14740/jmc3429

Utilization of intra-aortic balloon pump to allow MitraClip procedure in patients with non-coapting mitral valve leaflets: a case series.

BackgroundThe MitraClip (MC) procedure was designed for high-risk surgical patients with severe mitral regurgitation (MR). Some patients do not meet the required anatomical criteria due to advanced left ventricular remodelling and mitral annular dilatation leading to leaflet tethering and insufficient coaptation surface. Theoretically, ‘temporary remodelling’ of the mitral valve apparatus by pharmacological and/or mechanical support using intra-aortic balloon pump (IABP) could improve leaflets coaptation.Case summaryWe report a case series of four patients with severe MR and non-coapting leaflets who underwent MC implantation. Sufficient coaptation was achieved only after insertion of IABP. The first patient presented with worsening heart failure and severe MR after a non-reperfused posterior wall myocardial infarction (MI), underwent a successful procedure with good results. The second patient presented with worsening heart failure secondary to rheumatic MR, and underwent MC procedure with good results after the insertion of IABP. The third patient developed worsening heart failure and severe MR 2 months after an acute inferior-lateral MI, and underwent a successful procedure. The fourth patient presented with respiratory failure, the patient underwent the procedure, but unfortunately died a few days following the procedure from multiorgan failure. In each case, the insertion of the IABP decreased annular mitral diameter and increased the coaptation surface as assessed by transoesophageal echocardiography.DiscussionFor patients suffering from symptomatic severe MR who are not suitable candidates for MC procedure, IABP system enabled us to overcome mitral leaflet gap and complete the MC procedure successfully.

COMPARISON OF REVASCULARIZATION AND IN-HOSPITAL MORTALITY IN PATIENTS WITH TRUE POSTERIOR WALL MYOCARDIAL INFARCTION VERSUS OVERALL ST-ELEVATION MYOCARDIAL INFARCTION

Patients suffering from True Posterior Wall Myocardial Infarction (MI) have been classically described as being at an elevated risk of delayed diagnosis. This is due to absence of ‘traditional’ electrocardiographic infarct signs such as ST-segment elevation, which may result in errors or delays

Correlation between the diagnostic accuracy of the electrocardiogram and coronary angiography in localization of occluded artery in acute ST-elevation myocardial infarction: A single-center experience

Background: The electrocardiogram (ECG) remains the crucial tool in the diagnosis of acute ST-elevation myocardial infarction (STEMI) other than coronary angiography (CAG). However, the specificity of the ECG in culprit vessel localization is limited due to the individual variations in coronary anatomy as well as by the presence of preexisting coronary artery disease. The current observational study was designed to establish the correlation between the diagnostic accuracy of ECG with CAG to predict the culprit artery in STEMI. Materials and Methods: A total of 140 consecutive STEMI (ST elevation of >2 mm in at least 2 contiguous leads) patients were enrolled over 1.5 years at a tertiary care center in India. Based on ECG criteria, evaluated by blinded observer, patients were categorized into anterior, inferior with or without right ventricular infarction, and posterior wall myocardial infarction. Each group was further divided based on the culprit artery. Results: A total of 96 (68.6%) were males and 109 (77.9%) were 51–70 years. ECG showed perfect agreement (κ = 0.895, 0.882, and 0.853, respectively) with CAG in the diagnosis of proximal left anterior descending (LAD), proximal right coronary artery (RCA), and mid and distal RCA. It showed just fair agreement (κ = 0.348) with CAG in the diagnosis of distal LAD. Moreover, ECG showed perfect agreement (κ = 1) with CAG in the identification of both LAD proximal to D1 and distal to S1 and left circumflex artery. Conclusion: In STEMI patients, the diagnostic accuracy of ECG exhibits good correlation and agreement with CAG to predict the culprit vessels except for distal LAD.

ACCURACY OF 12 LEAD ECG FOR DIAGNOSIS OF POSTERIOR MYOCARDIAL INFARCTION TAKING 15 LEAD ECG AS GOLD STANDARD

INTRODUCTIONThe acute management of ST-elevation myocardial infarction (STEMI) is based on interpretation of the ECG. Thisis typically undertaken by doctors in the emergency department (ED) and acute medical unit. Increasingly, the ECGdiagnosis is being made by paramedics, allowing them to pre-alert the ED or even initiate thrombolytic therapy inregions where primary angioplasty is unavailable. Identification of ST-segment elevation or presumed new left-bundlebranch block in combination with a history of cardiac chest pain results in prompt initiation of reperfusion therapy.SUBJECT AND METHODA cross sectional study was done at Cardiology Department, Bolan Medical College, Quetta. Total duration was from01/02/2018-30/07/2018. 196 patients were recruited from Out Patient Department and Emergency Department of BolanMedical Complex, Quetta on the basis of inclusion/exclusion criteria, that is all patient with chest pain and age >18 and< 70 with posterior MI as per operational definition presenting within 12 hours of symptoms were included and allpatients with underlying LBBB on ECG, PPM and paced rhythm on ECG and pericardial effusion were excluded asthey are effect modifiers and bring bias in study.RESULTSTotal 196 patients were included in the study according to the inclusion criteria of the study. Mean age (years) in thestudy was 40.28+14.38 whereas there were 123 (62.8) male and 73 (37.2) female patients in the study. The diagnosticaccuracy, sensitivity, specificity, PPV and NPV of 12 lead ECG for diagnosis of posterior myocardial infarction taking 15lead ECG as gold standard was 82.14%, 87.12%, 57.58%, 91.03% and 47.50% respectively.CONCLUSIONThe study concludes that diagnostic accuracy of 12 lead ECG for diagnoses of posterior wall myocardial infarction washigh. The high sensitivity identified more patients to be re vascularized early.

In-Hosptal Outcome and Angiographic Findings in Acute Inferior Myocardial Infarction with ST-Segment Elevation in Posterior Chest Leads ( V7, V8, V9 ) Following Thrombolytic Therapy

Background: Electrocardiographic diagnosis of a posterior wall myocardial infarction is difficult to accomplish by the standard 12-lead ECG. Early detection of posterior wall involvement in an inferior myocardial infarction is of paramount importance for the therapeutic outcome. The aim of this study is to assess the role of ST segment elevation in posterior wall leads (V7, V8, V9) on the admission ECG of acute inferior myocardial infarction, for the diagnosis of posterior wall myocardial infarction and the identification of infarct related artery as well as in-hospital outcome following thrombolysis.Methods: A total of 90 patients with acute inferior MI were enrolled by purposive sampling. On the basis of ST segment elevation in posterior leads (V7,V8,V9), study subjects were categorized into two groups: 45 patients of acute inferior MI with ST segment elevation in posterior leads as group I and 45 patients of acute inferior MI without ST segment elevation in posterior leads as group II. Coronary angiography was done during index hospital admission. Interpretation of coronary angiogram was done by visual estimation by two cardiologists to assess the severity of coronary artery disease. Severity of coronary stenosis was graded according to the number of major epicardial vessel with significant stenosis by vessel score and Friesinger score. After CAG, patients were evaluated for in hospital adverse outcome like heart block, cardiogenic shock, arrhythmia, and death.Results: Patients of PMI and non PMI groups were similar in terms of age and sex. Smoking and dyslipidemia (p=0.05) were significantly higher in PMI group. Mean RBS and Troponin-I difference were significantly (p&lt;0.05) higher in group I. Majority of patients had ejection fraction 45-55% in both groups. Patients in group I showed more normal LVEF, than group II, which was statistically significant. This study provided the evidence that the ST segment elevation in posterior leads associated with more left circumflex (LCX) and posterior left ventricular brass (PLVB) involvement. Majority of the patients had vessel score 2, Friesinger score 5-10 in group I and vessel score 1, Friesinger score 1-4 in group II.Conclusion: ST segment elevation in posterior chest leads (V7, V8, V9) were associated with more in-hospital adverse outcome than those who had inferior MI alone. This group of patients had more PLVB involvement. Recording of posterior precordial leads appear to be beneficial for risk stratification and to locate the site of lesion in patients admitted with acute inferior myocardial infarction. Since it is inexpensive method, it may be used in any hospital.Bangladesh Heart Journal 2016; 31(2) : 58-64

Posterior wall myocardial infarction: A case report

Introduction. Acute myocardial infarction is a clinical manifestation of coronary disease which occurs when a blood vessel is narrowed or occluded in such a way that it leads to irreversible myocardial ischemia. ST segment depression in leads V1?V3 on the electrocardiogram points to the anterior wall ischemia, although it is actually ST elevation with posterior wall myocardial infarction. In the absence of clear ST segment elevation, it may be overlooked, leading to different therapeutic algorithms which could significantly affect the outcome. Case report. A 77 year-old female patient was admitted to the Coronary Care Unit due to prolonged chest pain followed by nausea and horizontal ST segment depression on the electrocardiogram in V1?V3 up to 3 mm. ST segment elevation myocardial infarction of the posterior wall was diagnosed, associated with the development of initial cardiogenic shock and ischemic mitral regurgitation. An emergency coronarography was performed as well as primary percutaneous coronary intervention with stent placement in the circumflex artery, the infarct-related artery. Due to a multi-vessel disease, surgical myocardial revascularization was indicated. Conclusion. Posterior wall transmural myocardial infarction is the most common misdiagnosis in the 12 lead electrocardiogram reading. Routine use of additional posterior (lateral) leads in all patients with chest pain has no diagnostic or therapeutic benefits, but it is indicated when posterior or lateral wall infarction is suspected. The use of posterior leads increases the number of diagnosed ST segment elevation myocardial infarctions contributing to better risk assessment, prognosis and survival due to reperfusion therapy.

ECG Diagnosis: Isolated Posterior Wall Myocardial Infarction.

Acute posterior wall myocardial infarction (PMI) occurs in up to 20% of cases of acute myocardial infarction (MI), with the vast majority occurring along with inferior or lateral acute MI. 1 A true PMI is considered more rare, with an incidence of approximately 3.3%. 2 The term PMI is used for necro sis of the part of the left ventricle located beneath the atrioventricular sulcus. 3 The majority of patients with the typical electrocardiogram (ECG) abnormalities of PMI have a stenosis or occlusion

Acute pontine infarction after percutaneous coronary intervention: a very rare but devastating complication

A 64-year-old man suffering from an acute posterior wall myocardial infarction underwent primary percutaneous coronary intervention. After several aspiration attempts, tirofiban infusion and pre- and post-dilatation, a bare-metal stent was successfully implanted in the culprit right coronary artery. While the patient did not show any neurological symptoms before or during the procedure, he exhibited hemiplegia and loss of spontaneous speech. Additional magnetic resonance imaging showed an extensive brain stem infarction. This is the first report of a brain stem infarction as a complication of percutaneous coronary intervention.Electronic supplementary materialThe online version of this article (doi:10.1007/s12471-015-0717-2) contains supplementary material, which is available to authorized users.

ATRIAL FIBRILLATION IN PATIENTS WITH INFERIOR MYOCARDIAL INFARCTION

Objective: To elucidate the mechanism of atrial fibrillation and evaluate left atrium function after restoration of sinus rhythm in patients with acute posterior wall myocardial infarction ( MI). Materials and Methods: The study included 53 patients with posterior wall MI.All patients were divided into 2 groups. The first group consisted of 33 a people with paroxysms of atrial fibrillation (AF), and the second included 20 control subjects without arrhythmia. All percutaneous intervention was performed within the first 24 hours. Patients were evaluated for time and duration of paroxysms, the size of the heart chambers and the recovery time of the left atrium (LA)function. Results: Patients with posterior wall myocardial infarction developed AF in the early stages of the disease (in 91% on the first day), with short duration of paroxysms, stopped spontaneously and often within 1 hour (in 11 people). There were no significant differences in the size of the heart chambers, left ventricular contractility and hemodynamic disturbances in patients of both groups. AF in most cases developed in patients without left ventricular failure (in 27 people; 82%). Wherein the proximal right coronary artery occlusion was observed more frequently in patients with atrial fibrillation, than in the control group (17 vs 2; p &lt;0,001). Approximately half patients(16 ) with AF before the appearance of atrial fibrillation bradysystolya of atria (less than 50 in 1 min) was recorded, due to acute sinus node dysfunction. After the reversion of sinus rhythm mechanical function of the LA was absent in only 4 people with left ventricular failure. Effective systole of LA was restored only 7 days after reversion to sinus rhythm. The rare occurrence of mechanical dysfunction after discontinuation of arrhythmia indicates a low probability of thrombosis and embolism in the systemic circulation. Conclusion: In cases of patients with posterior wall localization of MI main causes of AF include acute ischemia of atria due to occlusion of the right coronary artery above the branches supplying atrium. Atrial bradysystolya due to acute sinus node dysfunction often contributes to the development of AF as a substitute atrial rate (acute syndrome of tachy-bradycardia). In case of patients with posterior wall MI AF episodes were rarely accompanied by hemodynamic disturbances and the risk of systemic thromboembolism after reversion to sinus rhythm was low.

English

BACKGROUND AND OBJECTIVES: Posterior wall myocardial infarction is not uncommon acute myocardial infarction and has got its own therapeutic and prognostic implications. Management of Posterior wall myocardial infarction differs from inferior wall myocardial infarction alone. The presence of posterior wall myocardial infarction is known to increase the incidence of cardiogenic shock, arrhythmias and conduction blocks in case of myocardial infarction. Hence the present study was taken up to find out the incidence, clinical profile and complications of posterior wall myocardial infarction in a rural hospital using simple non-invasive investigations like 15 lead electrocardiography and echocardiography. METHODS: A prospective study was conducted on 50 patients of inferior wall myocardial infarction out of 228 Acute Myocardial Infarction proved by ECG standard and posterior leads (v7, v8, v9) were taken at the time of admission and repeated as necessary. A detailed case history was taken and a detailed physical examination was done at the time of admission and during follow up. For recording ECG 12 lead (3 standard leads, 3 augmented limb leads, 6 precordial leads) machine was used. The recordings were made at 25 mm/ sec. speed and 1mV=10mm. Posterior leads were taken by using 3 precordial leads fixing on the posterior axillary (v7), infrascapular (v8) and paraspinal (v9) regions all in a same line with the 5th ICS anteriorly. RESULTS: Out of 50 cases of inferior wall myocardial infarction (IWMI) studied only 13 (26%) had ST elevation in posterior leads indicating posterior wall myocardial infarction (PWMI). Our study showed that complications and mortality was higher in patients of IWMI with PWMI compared to IWMI without PWMI. Out of 50 patients 33 (66%) were males indicating a male predominance. Syncope was present in 18% of PWMI and 14% in overall IWMI. Palpitation was seen in 53% of PWMI and 21% of IWMI without PWMI. Smoking history was present in 14% of the patients with IWMI where as it was 42% in patients of PWMI. History of alcoholism was present in 22% of IWMI patients and 38% in the patients of PWMI and 6% in IWMI without PWMI. Diabetes was seen in 30% of PWMI patients where as it was 35% in patients IWMI without PWMI and 34% overall. Hypotension was present in 46% of PWMI and 16% of IWMI without PWMI. Ventricular fibrillation was seen in 8% of PWMI and 2.8% of patients of IWMI without PWMI. Heart blocks were seen in 15% of PWMI and in 10% of patients of IWMI without PWMI. Mortality was 23% in PWMI and 10% in patients of IWMI without PWMI. INTERPRETATION AND CONCLUSION: The incidence of mortality and complications can be reduced only when we are fully aware of diagnosis and complications that can occur in PWMI. So, in all cases of IWMI, PWMI should be looked for by using simple and specific investigation like Posterior leads ECG. It should be kept in mind that incidence of complications like hypotension, conduction defects and arrhythmias are very high in PWMI and hence early detection is important.

Factors associated with prehospital delay in patients with ST-segment elevation acute myocardial infarction in China

BackgroundPrehospital delay is the most critical factor to prognosis of ST-elevation myocardial infarction (STEMI). Few study had examined a series of predictors of prehospital delay by multivariate analysis of sociodemographic and clinical characteristics, onset features, and symptom condition of STEMI in China. MethodsA total of 1088 hospitalized STEMI participants were screened to collect sociodemographic data, medical history information, and symptom onset status from clinical medical records. Factors associated with prehospital delay were examined using bivariate and multivariate analysis method. ResultsThe median prehospital delay time (PDT) was 130 minutes in STEMI participants. Multivariate regression models examining 8 predictors were associated with prehospital delay, including senior high school or above educational level, myocardial infarction (MI) history, vertigo onset symptom, ambulance transportation, onset in daytime (6:00-18:00), onset at home, anterior wall MI, and posterior wall MI. Mortality in PDT more than 120 minutes group was 5.5%, whereas it was 4.3% in PDT 120 minutes of less group without significant statistically difference (P > .05). ConclusionsMultivariate analysis results found that symptom onset–related variables strongly influenced PDT. Onset-related status of STEMI needed to be combined into interventions of participants, and more emergency education should be recommended to both participants and their relatives. Most importantly, more efforts should be taken to educate the public about the symptoms and signs to increase the recognition of STEMI.

Allergic myocardial infarction

Allergic myocardial infarction

Localized pericarditis leading to clinical tamponade with profound shock status and syncope as a major clinical manifestation after posterior wall myocardial infarction—Characterization and descriptive findings by real-time 3-dimensional echocardiography

Pericarditis and hemopericardium causing cardiac tamponade, caused by large and transmural ventricular infarction with subsequent rupture into the pericardium, is a rare complication post acute myocardial infarction. This is frequently fatal with rapid clinical course. We reported a 65-year-old female who presented with persistent diaphoresis and dyspnea for several hours followed by syncope. Acute myocardial infarction was diagnosed with primary percutaneous coronary intervention performed though persistent hypotension was observed. Moderate amount of hemopericardium leading to tamponade was found. It was relieved after pericardiocentesis. Real-time three-dimensional echocardiography revealed blood clot with specific whirling pattern around the infracted ventricular wall with suspected leak.

Thrombosis of a large saphenous vein graft aneurysm leading to acute myocardial infarction 21 years after coronary artery bypass grafting: role of cardiac multi-slice computed tomography

We report a case of a 74-year-old male, who presented with an acute ST elevation posterior wall myocardial infarction (MI) 21 years following revascularization with three saphenous vein grafts (SVGs) to the left and right coronary arteries. In coronary angiography (CAG), the dilated SVG to the first marginal branch of the circumflex artery appeared only contrast enhanced in the proximal portion. The day after coronary angiography 128-slice cardiac computed tomography (CT) was performed. Cardiac CT showed a 5×3-cm incomplete thrombosed aneurysm of the proximal bypass with complete thrombotic occlusion of distal bypass grafting. With this diagnosis the patient was referred to a cardiothoracic unit for a second opinion. A surgical intervention was refused due to an increased intraoperative morbidity and occlusion of peripheral bypass portion. A follow-up CAG 10days after infarction showed complete occlusion of the aneurysm. This case illustrates the utility of multi-slice CT to diagnose SVG aneurysm and influence clinical decisions for further treatment. This is the first report of a spontaneous SVG aneurysm thrombosis under a conservative treatment approach with recovery of the patient after MI. Clinical follow-up five months after infarction was unremarkable.

Acute Left Ventricular Rupture Following Posterior Wall Myocardial Infarction

Free wall rupture, the most fearful complication of myocardial infarction, mostly attacks anterior walls. Acute rupture is characterized by rapid development of mechanical arrest accompanied with bradyarrhythmia or electromechanical dissociation. The majority of patients succumb to death as the result of cardiac tamponade. Risk factors are advanced age, female gender, the first-time myocardial infarction, hypertension, and ST-segment elevation. We report a rare case of posterior wall myocardial infarction complicated with left ventricular rupture initially presenting with junctional escape rhythm.