Myocardial free wall rupture as a complication of STEMI
Authors:
Lukáš Urban 1,2; Milan Dragula 2; Tomáš Bolek 1; Miloš Kňazeje 2; Matej Samoš 1
Authors‘ workplace:
I. interná klinika, Jesseniova lekárska fakulta v Martine, Univerzita Komenského v Bratislave, Univerzitná nemocnica Martin
1; Kardiologické oddelenie, Univerzitná nemocnica Martin
2
Published in:
Vnitř Lék 2022; 68(3): 187-190
Category:
Case reports
Overview
Myocardial free wall rupture is a rare, but serious complication of acute myocardial infarction with high mortality. We present a case of a 64-year-old patient with this devastating complication of an anterior ST segment elevation myocardial infarction (STEMI) with a prolonged time delay. Cardiac surgery was not performed due to prohibitive surgical risk and predicted poor prognosis. We describe our successful therapeutic intervention consisting of immediate pericardial drainage, vasoactive and inotropic support, intraaortic balloon pump placement and continuous veno-venous hemodialysis. This combined therapy led to patient stabilization and after incremental clinical improvement the patient was able to return to a normal life. After several months a long-term mechanical circulatory support was implanted as a bridge to heart transplant.
Keywords:
myocardial infarction – myocardial free wall rupture – cardiac tamponade
Sources
1. Figueras J, Alcalde O, BarrabésJosé A et al. Changes in hospital mortality rates in 425 patients with acute st‑elevation myocardial infarction and cardiac rupture over a 30-year period. Circulation. 2008;118:2783–2789. doi: 10.1161/circulationaha.108.776690.
2. Elbadawi A, Elgendy IY, Mahmoud K et al. Temporal trends and outcomes of mechanical complications in patients with acute myocardial infarction. JACC: Cardiovascular Interventions. 2019;12:1825–1836. doi: 10.1016/j.jcin.2019. 04. 039.
3. Matteucci M, Fina D, Jiritano F, et al. Treatment strategies for post‑infarction left ventricular free‑wall rupture. European Heart Journal: Acute Cardiovascular Care. 2019;8:379-387. doi: 10.1177/2048872619840876.
4. Moreno R, López‑Sendón J, García E et al. Primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction. Journal of the American College of Cardiology. 2002;39:598-603. doi: 10.1016/s0735-1097(01)01796-x.
5. Lancellotti P, Price S, Edvardsen T et al. Theuse of echocardiography in acute cardiovascular care: Recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. European Heart Journal: Acute Cardiovascular Care. 2015;4:3-5. doi: 10.1177/2048872614568073.
6. Reardon MJ, Carr CL, Diamond A et al. Ischemic left ventricular free wall rupture: Prediction, diagnosis, and treatment. The Annals of Thoracic Surgery. 1997;64:1509-1513. doi: 10.1016/s0003-4975(97)00776-5.
7. Leva C. Complete myocardial revascularization and sutureless technique for left ventricular free wall rupture: Clinical and echocardiographic results. Interactive CardioVascular and Thoracic Surgery. 2006;5:408-412. doi: 10.1510/icvts.2006.131037.
8. Blinc A, Noč M, Pohar B et al. Subacute rupture of the left ventricular free wall after acute myocardial infarction. Chest. 1996;109:565-567. doi: 10.1378/chest.109. 2. 565.
9. Formica F, D‘Alessandro S, Singh G, et al. Left ventricular free wall rupture after myocardial infarction: Still a challenging complication. The Journal of Thoracic and Cardiovascular Surgery. 2019. doi: 10.1016/j.jtcvs.2019. 05. 038.
10. Khalid N, Rogers T, Shlofmitz E et al. Adverse events and modes of failure related to the impella percutaneous left ventricular assist devices: A retrospective analysis of the maude database. EuroIntervention. 2019;15:44-46. doi: 10.4244/eij‑d-18-01021.
11. Ghionzoli N, Sciaccaluga C, Mandoli GE, et al. Cardiogenic shock and acute kidney injury: The rule rather than the exception. Heart Failure Reviews. 2020;26:487-496. doi: 10.1007/s10741-020-10034-0.
12. McDonagh TA, Metra M, Adamo M et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2021;42:3599-3726. doi: 10.1093/eurheartj/ehab368.
13. Frances C, Romero A, Grady D, et al. Left ventricular pseudoaneurysm. Journal of the American College of Cardiology. 1998;32:557-561. doi: 10.1016/s0735-1097(98)00290-3.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2022 Issue 3
Most read in this issue
- Differential diagnosis of chronic lower limb edema
- Hypertension and dyslipidemia treament in stroke
- Use of telemedicine in patients with heart failure
- Beta‑blockers after myocardial infarction and chronic coronary heart disease