Perioperative Management of a Patient With Left Ventricular Free Wall Rupture After Myocardial Infarction: A Rare Case Scenario

Abstract

Myocardial infarction (MI) is typically followed by numerous lethal complications. One such complication is left ventricular free wall rupture (LVFWR). We present the case of a middle-aged hypertensive patient who had a history of unstable angina for seven days. He presented to the emergency room with chest pain, dyspnea, and unstable vital parameters. Clinical signs, electrocardiography, and echocardiography raised the suspicion of left ventricular free wall rupture with ST-segment elevation inferior wall and lateral wall MI. As a result, the patient received aggressive resuscitative measures. Later, he underwent surgical repair for cardiac rupture via cardiopulmonary bypass. Finally, the patient was discharged from the hospital on the 10 th postoperative day. The window period from the onset of cardiac wall rupture to patient admission to the operating room is crucial. This case report highlights that a high index of suspicion for left ventricle free wall rupture should be considered for a patient presenting with MI and cardiogenic shock. Timely diagnosis and quick surgical intervention can deter complications and save the patient.

Managing Ventricular Wall Rupture as a Complication of Late Presentation MI in a Complex Patient with Ankylosing Spondylitis

“…Ventricular free wall rupture is an infrequent but serious complication that occurs within the first 96 hours post-MI with mortality rates as high as 88.2% [ 1 ]. Cardiac surgery is the mainstay of treatment [ 2 ], but despite surgical intervention, patients who undergo successful repair have a 58.9% survival rate after 3 years [ 3 ]. In recent years, the COVID-19 pandemic has had a dramatic effect on life in the world and has significantly impacted and burdened the medical community.…”