Left Ventricular Rupture
A 72-year-old woman with hypertension presented to a local hospital with a 5-day history of nausea, sharp epigastric pain, shortness of breath, and malaise. Electrocardiography revealed anterolateral ST-segment elevations, which prompted her transfer to a tertiary care facility for primary percutaneous coronary intervention. In the cardiac catheterization laboratory, radial-artery access was obtained, and the patient suddenly lost consciousness and became pulseless. Cardiopulmonary resuscitation was initiated. Ultrasonography revealed a large pericardial effusion without a clot. Pericardiocentesis was performed, and circulation was restored. Ventriculography revealed a free-wall rupture (red arrow) along with an occluded diagonal coronary branch (black arrow) (see video). The patient received continuous autotransfusion of blood from a pericardial catheter (white arrow) to a peripheral vein and underwent surgical repair of the large free-wall rupture. For treatment of stenosis of the distal left anterior descending artery, a saphenous-vein graft bypass was performed. Acute rupture of the left ventricular free wall can be a complication of late-presenting myocardial infarction. The patient recovered postoperatively and was doing well 6 months later. Her most recent left ventricular ejection fraction was 52%.
Source: https://youtu.be/gEIOpPTROlk?si=JXC93edn4Awnjkud