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Contained Left Ventricular Free Wall Rupture following Myocardial Infarction

DOI: 10.1155/2012/467810

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Abstract:

Rupture of the free wall of the left ventricle occurs in approximately 4% of patients with infarcts and accounts for approximately 20% of the total mortality of patients with myocardial infractions. Relatively few cases are diagnosed before death. Several distinct clinical forms of ventricular free wall rupture have been identified. Sudden rupture with massive hemorrhage into the pericardium is the most common form; in a third of the cases, the course is subacute with slow and sometimes repetitive hemorrhage into the pericardial cavity. Left ventricular pseudoaneurysms generally occur as a consequence of left ventricular free wall rupture covered by a portion of pericardium, in contrast to a true aneurysm, which is formed of myocardial tissue. Here, we report a case of contained left ventricular free wall rupture following myocardial infarction. 1. Introduction Rupture of the free wall of the left ventricle occurs in approximately 4% of patients with myocardial infarction (MI) and accounts for approximately 20% of mortality of these patients [1, 2]. Premortem diagnosis of rupture is made in approximately 15% of in-hospital deaths from acute MI in a coronary care unit [3]. However, one series of autopsies claims that up to 31% of MI fatalities had cardiac rupture. Hence, relatively few cases of left ventricular free wall rupture (LVFWR) are diagnosed before death. Nevertheless, the increased availability of bedside echocardiography has contributed to a progressive rise in the number of cases of LVFWR being diagnosed and reported. Several distinct clinical forms of ventricular free wall rupture have been identified [4]. Sudden rupture with massive hemorrhage into the pericardium is the most common form; in a third of the cases, the course is subacute with slow and sometimes repetitive hemorrhage into the pericardial cavity [5]. Left ventricular pseudoaneurysm is a variant of left ventricular rupture that generally occurs as a consequence of LVFWR covered by a portion of pericardium. Here, we report a case of contained left ventricular free wall rupture following myocardial infarction. 2. Patient Description An 80-year-old retired female resident of a home for the aged was admitted with recent complaints of dyspnea, dizziness, and a falling episode with a possible loss of consciousness. Her personal history revealed mild dementia, Parkinson’s disease treated with carbidopa and levodopa, hypertension treated by nifedipine, and dyslipidemia treated by statins. Additional medications included acetylsalicylic acid (100?mg?qd), calcium supplements, and

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