Multiple Complications Following Acute Myocardial Infarction: A Case Report

Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. Despite advances in early reperfusion and percutaneous coronary intervention (PCI), a subset of patients develops severe arrhythmic, thrombotic, and mechanical complications that markedly worsen prognosis and require rapid recognition and multidisciplinary management. We describe a 66-year-old man with multiple cardiovascular risk factors who presented with an anteroseptal ST-elevation myocardial infarction and underwent urgent PCI with stent implantation in the left anterior descending artery. Eighteen hours later, he developed recurrent ischemia due to acute stent thrombosis, consistent with type 4b myocardial infarction, requiring repeat coronary intervention. His subsequent intensive care unit course was complicated by atrial fibrillation, acute ischemic heart failure, and progressive hemodynamic instability. Bedside transthoracic echocardiography identified a left ventricular aneurysm with intracavitary thrombus, severely reduced left ventricular ejection fraction, and a large pericardial effusion causing cardiac tamponade. Emergency surgical pericardial window confirmed hemopericardium. After prompt surgical intervention and optimization of guideline-directed medical therapy, the patient achieved clinical stabilization and was discharged with close follow-up. This case highlights the dynamic and multifaceted nature of AMI, emphasizing that even with timely reperfusion, patients may develop a cascade of life-threatening complications. Early clinical vigilance, repeated imaging, and coordinated multidisciplinary care are essential to improve outcomes in complex post-infarction presentations.