Title : left ventricular apex rupture in STEMI
Author : Mohamed Amr, MD
Affiliation : Department of Internal Medicine, Rochester General
Hospital, Rochester, NY.
Corresponding Author : Mohamed Amr, MD
Contact number : 718-764-7202
Affiliation Address : 1425 Portland Avenue, Rochester, NY,
14621.
Email address : amrelwagdycardiol@gmail.com
Funding source : none
Conflict of interest : none
Article type : Clinical image
Word count : 156
Keywords : STEMI, mechanical complications.
A 56-year-old male with a past medical history of diabetes presented
with chest pain of 23-hour duration. His BP was 150/80, pulse 120, SO2
89%. His examination was remarkable for congested neck veins but no
murmurs. Chest auscultation showed bubbling crepitation.
EKG revealed anterior STEMI. Because of acute severe heart failure, we
performed a bedside echocardiogram. It showed ejection fraction(EF) of
20%, perforated LV apex with apical pseudoaneurysm. There was effusion
around the right ventricle (RV) with tamponade. Emergency coronary
angiography revealed total proximal left anterior descending(LAD) artery
occlusion. Emergency cardiac surgery was performed to reconstruct the LV
apex and revascularize the LAD by venous graft. The rest of the hospital
course stay was uneventful.
The critical clinical message is to know that Mechanical complications
are rare. A high index of suspicion facilitates diagnosis. The presence
of acute heart failure should ring an alarm. Other red flags are
cardiogenic shock, new murmur, or evidence of hypoperfusion.