Rupture of the cardiac free wall after infarction confirmed by aortic CTA

Abstract

Abstract Background Free wall rupture is a rare complication of myocardial infarction, occurring as early as a few hours after myocardial infarction. It usually happens after transmural myocardial infarction and has a very high mortality rate. The diagnosis of free wall rupture requires echocardiographic evidence of pericardial leakage or pericardial tamponade. The patient's cause of death is often attributed to other causes such as cardiac arrhythmia unless determined by open heart surgery or autopsy. Diagnostic tools for post-infarction cardiac free wall rupture are limited to date.Case presentation We report a patient with myocardial infarction who presented with atypical chest pain. Subsequent coronary angiography suggested small vessel disease, but the patient's severe clinical presentation was not consistent with small vessel disease. Considering the patient's non-excluded aortic coarctation and the small size of the vascular lesion, no intervention was performed for the time being. Next, to further clarify the diagnosis, the patient underwent an aortic computed tomography angiography (CTA). In the aortic CTA a rupture of the free wall of the heart was detected and a large amount of bloody pericardial effusion was found. Unfortunately, the patient did not have a successful puncture and drainage, and died after resuscitation.Conclusions The diagnosis of cardiac rupture is a challenge. We need to be alert to the possibility of cardiac rupture even in small vascular lesions. When patients present with more severe clinical manifestations that are not consistent with myocardial infarction, it is important to be alert to the possibility of cardiac rupture in addition to identifying the possibility of aortic coarctation. Aortic CTA may be able to confirm the diagnosis when neither echocardiography nor coronary angiography is used to detect such occurrences of cardiac rupture.