Background Left ventricular free wall rupture is an uncommon but catastrophic event following myocardial infarction, and considered the second leading cause of death in acute myocardial infarct. Different types of rupture exist from acute to sub acute types, but prognosis is usually poor. Early recognition and aggressive treatment is recommended.Case report We present a case of a 75-year-old man who was referred to our echo-lab for an out patient evaluation because of 1-week duration of worsening of chest pain. Standard transthoracic echocardiography showed hypokinesia in the apical portion of the anterior wall and basal portion of the inferior wall. The patient complained of shortness of breath immediately after the conclusion of the exam, and soon afterward became unconscious. Renewed echocardiography approximately 1 min after syncope displayed a newly developed echo-lucent rim around the heart consistent with left ventricular free wall rupture. Resuscitation was performed followed by attempts to evacuate the blood by needle aspiration, which failed. Open pericardiocentesis stabilised the patient until surgery could be performed. The patient survived and could be discharged 2 weeks later. Conclusion This case highlights the fact that rapid and accurate diagnosis is essential if patients with left ventricular free wall rupture are to survive.
Objective/Background: Reports on heart failure (HF) predictors are scarce. We assessed gender-specific HF predictors.Design: Preventive case-finding programme, register study.Setting: City population-based sample. Methods:We examined 33,342 HF-free subjects, 32.7% women, included in Malmö Preventive Project. Mean inclusion age was 49.7±7.4 years for women and 43.7±6.6 years for men.Results: During 21.7±4.3 years of average follow-up, 764 (2.3%) subjects were diagnosed with HF, 120 (1.1%) women and 644 (2.9%) men. Following bootstrap analysis, the only strong independent predictor of HF among women was smoking. Independent predictors of HF among men were diastolic blood pressure (BP), fasting blood-glucose, smoking, family history of myocardial infarction, and previous cardiovascular disease (CVD). During follow-up, 5,370 (16.1%) subjects died, 978 (9.0%) women and 4,392 (19.6%) men. Among both women and men, strong independent predictors of combined HF or all-cause death were high serum-triglycerides, fasting blood-glucose and estimated glomerular filtration rate, smoking, and previous CVD. Among men, also underweight, high BMI, and systolic and diastolic BP, were strong independent predictors of HF or death. Conclusions:Although women and men shared many predictors of HF, there were several important differences between sexes.
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