title: Leaking heart: ticking time bomb!
abstract: BACKGROUND
  Cardiac rupture is a very important but under-recognized complication of acute myocardial infarction and usually happens within a week of the event. Sometimes it can be subacute and may not be typical of an acute blow out rupture. Hence careful evaluation is needed as a missed or delayed diagnosis can be fatal. An emergent echocardiogram may aid in immediate diagnosis. Surgery is the only treatment option and is mandatory despite the high mortality risk.
  
  
  METHODS
  An elderly male presented with dizziness and hypotension. Based on the timeline of his symptomatology, electrocardiographic abnormalities and labs, a subacute cardiac rupture was suspected in the emergency room itself. A high index of suspicion is needed to diagnose cardiac rupture.
  
  
  CONCLUSIONS
  Subacute cases can be missed easily as presentation may not be dramatic. They can rapidly progress to a blowout rupture increasing mortality risk heavily even with surgical treatment.
authors.affiliation: Department of Internal Medicine, Banner Estrella Medical Center, Phoenix, AZ, USA.
authors.forename: Punnaiah
authors.initials: P
authors.lastname: Marella
authors.affiliation: Department of Internal Medicine, West Valley Medical Center, Goodyear, AZ, USA.
authors.forename: Hassan
authors.initials: H
authors.lastname: Hussein
authors.affiliation: Department of Cardiology, Sanford Health, Sioux Falls, South Dakota, USA.
authors.forename: Naveen
authors.initials: N
authors.lastname: Rajpurohit
authors.affiliation: Department of Cardiology, Banner Estrella Medical Center, Phoenix, AZ, USA.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Garg
keywords: Acute myocardial infarction; Echocardiography; Pericardial effusion; Ventricular free wall rupture