title: Early diagnosis and management of myocardial rupture.
abstract: Left ventricular free wall rupture is a catastrophic mechanical complication of myocardial infarction. We present an 82-year-old woman with an anterolateral ST segment elevation myocardial infarction treated with thrombolysis. Because of unexplained hypotension, echocardiography was performed and contrast (Definity; Lantheus Medical Imaging) was used to improve visualization. Findings included a small- to moderate-sized circumferential pericardial effusion without frank tamponade, however, there was significant intramyocardial tracking of the contrast into the epicardial space, localized to the mid to apical portion of the anterior septum, consistent with rupture or disruption of the wall segment. The patient was promptly taken to the operating room where fresh blood and clots were evacuated from the pericardial space with immediate hemodynamic improvement. The patient underwent successful surgical repair.
authors.affiliation: Section of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: umlius3@myumanitoba.ca.
authors.forename: Shuangbo
authors.initials: S
authors.lastname: Liu
authors.affiliation: Section of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Tamara
authors.initials: T
authors.lastname: Glavinovic
authors.affiliation: Section of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: James W
authors.initials: JW
authors.lastname: Tam
mesh_terms: D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000000981:diagnostic imaging* / Q000601:surgery; D006352:Heart Ventricles; D006801:Humans