Double cardiac rupture in the course of infarction

Abstract

A 67-year-old man was admitted to hospital suffering from chest pains and electrocardiographic myocardial infarction with ST-segment elevation of the inferior wall, left and right ventricular infarction and cardiogenic shock. An emergency coronary angiography revealed total occlusion of the right coronary artery and absence of any collateral circulation. This was effectively recanalised with the implantation of a stent (TIMI 3 flow). Transthoracic echocardiography revealed a post-infarction ventricular septal defect with an essential left-toright shunt. Standard pharmacotherapy without the possibility of connection to an intra-aortic balloon pump did not improve the haemodynamic parameters of the patient. After performing a delayed but successful recanalisation of the infarcted coronary artery within two hours there was a rupture in the free wall of the left ventricle at the border with the site of the infarct, which led to the sudden death of the patient. Correct diagnosis of the disputable double cardiac rupture was established by means of echocardiography.