Perforated ventricular aneurysm in a male suffering from pneumonia

Abstract

Summwy:In a 49-year-old male with fever, dyspnea, and chest pain, thoracic x-ray revealed pneumonia with enlarged heart silhouette. Antibiotics were successful, pneumonia healed and complaints disappeared. Yet, during the following 3 months, echocardiography showed mild persistent pericardial effusion while in ECG both sinus tachycardia rind ST-T changes were found suggesting chronic pericarditis. Magnetic resonance imaging, however, revealed an extensive posterobasal aneurysm with pericardial effusion substantiated by ventriculography. Coronary angiography showed diffuse three-vessel disease. Surgery revealed aneurysm with distinct perforation of the left ventricle and pericardial thrombi, thus aneurysmectomy as well as bypass grafts were performed. One year postoperatively. magnetic resonance imaging confirmed the absence of aneurysm with only a small irreversible posterobasill perfusion defect remaining as shown by thallium scint i grilph y. In this case report a male suffering from pneumonia and silent myocardial infarction is presented in which ventricular aneurysm and cardiac rupture developed as complications. Case ReportThis 49-year-old office employee was admitted to the hospital because of fever, dyspnea, and chest pain. In past medical history the patient underwent appendectomy, tonsillectomy in early years, and had hepatitis 25 years ago. He stated smoking 40 pack years, whereas no further cardiac risk factors were established. Three weeks prior to admission the patient suffered an attack of flu with temperature, exhaustion, and diffuse muscle pain. These symptoms increased in the days before entering the hospital and chest pain occurred.Upon admission temperature reading was 105"E pulse frequency 84 beatslmin and blood pressure 135/105. Heart beats were normal without evidence of heart murmurs, but left lung basis revealed signs of pneumonia. Laboratory findings were: serum glutamic oxaloacetic transferase (SGOT) 63 U/1 (0-18), serum glutamic pyruvate transferase (GPT) 121 UA (0-22), gamma glutamyltransferase 205 U/1 (6-28), alkaline phosphatase 198 U/I (60-1 lo), glucose 131 mg/dl(76-1 lo), leukocyte 19.000/mm3 (absolute lymphopenia). Hepatitis A antibodies (IgG+IgM) were positive, hepatitis B markers negative as well as viral status and blood culture. ECG revealed sinus tachycardia with complete right bundle-branch block but without ST-T deviations. X-ray confirmed pneumonia in the left lower lobe with additional slight pleural effusion and general heart enlargement suggesting pericardial effusion.The patient received antibiotics bringing about normalization of temperature within one week and chest pain resolving from Day 2 of treatment. On Day 7 patient suf-854 Clin. Cardiol. Vol. 14. October 1991 i'ered ;I collapse while still in bed with intense reduction in blood pressure (80/50) and increase in pulse frequency ( I 1 0 hpm), whereupon he was transferred to the intensive care station for observation. At that time, cardiac enzymes and leukocyte count were normal, he had no signs of heart failure...