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Cardiac rupture following acute myocardial infarction: a case with successful surgical treatment
T K Nasser1, W K Nasser, J D Slack
1Indiana Heart Institute, St. Vincent Hospital.
Insights
A patient with myocardial infarction and cardiogenic shock was found to have cardiac rupture. Echocardiogram revealed a pericardial effusion and mass, leading to successful emergency surgery and patient survival.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Acute myocardial infarction (MI) can lead to cardiogenic shock.
- Cardiogenic shock typically results from extensive myocardial damage.
Observation:
- A patient presented with lateral wall MI and severe cardiogenic shock.
- Cardiac catheterization and angiography showed minimal coronary artery disease and preserved left ventricular function.
- Echocardiography revealed a moderate pericardial effusion with an echo-dense mass, suggesting subacute cardiac rupture.
Findings:
- The primary cause of cardiogenic shock was not epicardial coronary artery occlusion.
- Subacute cardiac rupture, specifically a free wall rupture, was identified as the cause of hemodynamic compromise.
- The echocardiogram was crucial in diagnosing the unexpected cardiac rupture.
Implications:
- This case highlights the importance of echocardiography in diagnosing atypical causes of cardiogenic shock post-MI.
- Early diagnosis and surgical intervention for cardiac rupture can lead to patient survival.
- Unexplained cardiogenic shock warrants a thorough investigation beyond coronary angiography.
Abstract:
This report involves a patient who sustained an acute lateral wall myocardial infarction complicated by cardiogenic shock. Cardiac catheterization revealed diastolic equilibration of all intracardiac pressures. Cardiac angiography revealed only acute occlusion of a small branch of the left circumflex coronary artery with good left ventricular systolic function. Since these findings could not explain the degree of cardiogenic shock, an immediate echocardiogram revealed a moderate pericardial effusion with an echo-dense mass suggestive of subacute cardiac rupture. Emergency cardiac surgery confirmed the diagnosis and successful surgical correction resulted in survival of the patient.