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Post-myocardial Infarction Left Ventricular Aneurysm With Contained Rupture and Hemopericardium
Moiz Saeed1, Rand Sabanci1, Adolfo Martinez1
1Internal Medicine, Michigan State University, East Lansing, USA.
Insights
This case study highlights a rare instance of left ventricular aneurysm rupture leading to cardiac tamponade. Prompt diagnosis and imaging are crucial for managing this life-threatening complication of myocardial infarction.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiovascular Surgery
Background:
- Left ventricular aneurysms (LVAs) are rare complications of myocardial infarction (MI).
- Mechanical complications of MI, such as LVAs, can lead to significant morbidity and mortality.
- Contained aneurysm rupture with hemopericardium is an infrequent presentation of LVA.
Observation:
- An 88-year-old male presented with symptoms suggestive of acute coronary syndrome.
- Echocardiography revealed a left ventricular aneurysm with pericardial effusion and tamponade physiology.
- CT angiography confirmed hemopericardium, indicating contained rupture.
Findings:
- The patient experienced hemodynamic instability requiring intensive care and vasopressor support.
- Echocardiography and CT angiography were crucial for diagnosing the LVA and associated complications.
- LVAs can lead to serious complications including tamponade, arrhythmias, and thromboembolism.
Implications:
- Early clinical suspicion and prompt diagnostic imaging are vital for identifying LVAs and their complications.
- Further research is needed to establish optimal management strategies, including surgical versus percutaneous interventions.
- This case underscores the importance of considering rare mechanical complications in patients with a history of MI.
Abstract:
Left ventricular aneurysms (LVAs) represent a rare yet critical complication arising from late-presenting myocardial infarction (MI). Here, we present the case of an 88-year-old male with chest pressure, elevated troponin, B-type natriuretic peptide, and lactate. The electrocardiogram showed sinus tachycardia and an old right bundle branch block. The patient was started on heparin infusion, but progressively worsening hypotension necessitated transfer to the intensive care unit and the initiation of vasopressors. The echocardiogram identified a focal aneurysm in the mid-anterolateral wall, moderate pericardial effusion with a coagulum, and tamponade physiology. Computed tomography angiography of the chest confirmed a moderate pericardial effusion with density consistent with hemopericardium. LVAs pose a substantial threat of cardiovascular morbidity and mortality. While echocardiography serves as the initial assessment method, supplemental imaging modalities may need to be utilized. Various complications have been reported with LVA, including thromboembolization, ventricular arrhythmias, pericardial effusion with tamponade, and left ventricular rupture which accounts for 5%-24% of all in-hospital deaths related to MI. Although LVAs are the most common mechanical complications following an MI, instances of contained aneurysm rupture leading to hemopericardium are infrequent and scarcely reported. High clinical suspicion and prompt imaging with echocardiography are essential for diagnosis. Determining the optimal timing and selection between surgical and percutaneous interventions necessitates additional research for informed decision-making.
