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Pseudoaneurysm Development after Free Wall Rupture Post Myocardial Infarction
Steven Douedi1, Nasam Alfraji1, Vandan D Upadhyaya1
1Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA.
Insights
This case study highlights a fatal left ventricular pseudoaneurysm rupture following a myocardial infarction. Early diagnosis and management are crucial for this rare but deadly cardiac complication.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Background:
- Cardiovascular disease is the leading global cause of death.
- Myocardial infarction (MI) is a significant contributor to cardiovascular mortality.
- Complications like left ventricular rupture and aneurysms increase MI morbidity and mortality.
Observation:
- An elderly male with a history of cardiac disease presented with non-ST segment myocardial infarction (NSTEMI).
- Following percutaneous coronary intervention, he developed hemodynamic instability and was diagnosed with a left ventricular pseudoaneurysm.
- Despite aggressive management, the pseudoaneurysm ruptured, leading to the patient's death.
Findings:
- Left ventricular pseudoaneurysms occur post-MI, carrying a substantial rupture risk (up to 45%) and mortality rate (around 50%).
- Diagnosis is typically confirmed by cardiac catheterization with left ventriculography, though echocardiography serves as a viable alternative.
- Emergent cardiac surgery is the standard treatment, but it carries significant operative risks.
Implications:
- This case underscores the critical nature of left ventricular pseudoaneurysms as a life-threatening complication of MI.
- Prompt diagnosis and consideration of surgical intervention, potentially after medical stabilization, are crucial for improving patient outcomes.
- Further research into optimizing management strategies for these high-risk patients is warranted.
Abstract:
Background: According to the World Health Organization, cardiovascular disease is the number one cause of death globally, claiming millions of lives each year with an increasing prevalence. Myocardial infarction (MI) makes up a large sum of these deaths each year. While MI in itself is lethal, there are several complications that can increase the morbidity and mortality of an MI, such as left ventricular wall rupture and aneurysms. Case Presentation: We present a case of an elderly male with an extensive cardiac history who presented with a non-ST segment myocardial infarction (NSTEMI) managed with percutaneous coronary intervention. Hours after, he became hemodynamically unable and was found to have a pseudoaneurysm of the left ventricle. Despite aggressive efforts, his pseudoaneurysm ruptured and he ultimately succumbed to his condition. Conclusions: Left ventricular pseudoaneurysm is usually seen after myocardial infarctions with a rupture rate of up to 45% leading to a mortality rate of about 50%. While cardiac catheterization with left ventriculography is the gold standard for diagnosis, echocardiography can also be used as an alternative. Treatment is emergent cardiac surgery but still holds a high operative risk. Therefore, patients may be medically stabilized and managed prior to ultimate surgical intervention.
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