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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
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Non-ST-segment elevation myocardial infarction with evidence of transmural infarction complicated by left ventricular

Niall Pe Connolly1, Breda Hennessey2, Darren Mylotte3

  • 1Cardiology, Galway University Hospital, Galway, Ireland niallcon@gmail.com.

BMJ Case Reports
|November 1, 2020
PubMed

Insights

A rare case of fatal left ventricular free wall rupture occurred in a patient with non-ST-segment elevation myocardial infarction. This emphasizes that mechanical complications can arise in non-ST-segment elevation myocardial infarction, not solely ST-segment elevation myocardial infarction.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Medical Case Reports

Background:

  • Non-ST-segment elevation myocardial infarction (NSTEMI) typically presents with different risk profiles for mechanical complications compared to ST-segment elevation myocardial infarction (STEMI).
  • Left ventricular free wall rupture is a rare but catastrophic mechanical complication of myocardial infarction.

Observation:

  • A 68-year-old man experienced sudden hemodynamic collapse during percutaneous coronary intervention for NSTEMI.
  • Transthoracic echocardiography revealed pericardial tamponade.
  • Postmortem examination confirmed a complete transmural myocardial infarction with left ventricular free wall rupture.

Findings:

  • The patient's fatal outcome was attributed to left ventricular free wall rupture, electromechanical dissociation, and cardiac tamponade.
  • The autopsy findings confirmed transmural infarction as the cause of the rupture.

Implications:

  • This case highlights that transmural infarction and subsequent mechanical complications, such as ventricular rupture, can occur in NSTEMI.
  • Clinicians should maintain a high index of suspicion for mechanical complications in NSTEMI, even in the absence of ST-segment elevation.
  • Early recognition and management of mechanical complications are crucial, although this case ended fatally.

Keywords:
cardiovascular medicineinterventional cardiologyischaemic heart disease

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