Unusual Cause of Heart Failure in a 65‐Year‐Old Woman

Abstract

Left ventricular (LV) free wall rupture is a potentially lethal mechanical complication after myocardial infarction (MI). Pericardial adhesions or slow extracardiac leak and pericardial inflammation may result in a contained cardiac rupture. LV pseudoaneurysm is a relatively uncommon clinical entity. It may occur after MI, but also as a complication of infective endocarditis, cardiac surgery, or trauma. Patients developing LV pseudoaneurysm after MI may present angina pectoris or signs of congestive heart failure (HF) but often are asymptomatic. Surgery is the treatment of choice for LV pseudoaneurysms diagnosed in the first months after MI. The management of chronic LV pseudoaneurysms is still subject of debate. This report highlights a 65-year-old patient newly hospitalized for acute decompensated HF who was diagnosed with a large chronic LV pseudoaneurysm and severe mitral regurgitation. The patient underwent successful resection of the pseudoaneurysm and patch repair of the ruptured ventricular wall. (ECHOCARDIOGRAPHY, Volume 25, November 2008) left ventricular pseudoaneurysm, mitral regurgitation, heart failure Left ventricular (LV) free wall rupture is a potentially lethal mechanical complication after myocardial infarction (MI). Pericardial adhesions or slow extracardiac leak and pericardial inflammation may result in a contained cardiac rupture. 1 LV pseudoaneurysm is a relatively uncommon clinical entity. It may occur after MI, but also as a complication of infective endocarditis, cardiac surgery, or trauma. Patients developing LV pseudoaneurysm after MI may present angina pectoris or signs of congestive heart failure (HF) but often are asymptomatic. 2 Surgery is the treatment of choice for LV pseudoaneurysms diagnosed in the first months after MI. 3-5 The management of chronic LV pseudoaneurysms is still a subject of debate. This report highlights a 65-year-old patient newly hospitalized for acute decompensated HF who was diagnosed with a large chronic LV pseudoaneurysm and severe mitral regurgitation.A 65-year-old female patient was admitted to our hospital for paroxysmal nocturnal dyspnea and severe fatigue. The patient presented exertional dyspnea for 6 months prior to admission and did not experience chest pain, palpitations or syncope. There was no history of cardiovascular disease and no significant cardiovascular risk factor. She was known to have calcified hydatid cyst of the liver. Physical examination revealed a regular heart rate of 100 beats/min, a blood pressure of 130/70 mmHg, a downward and leftward displacement of the apex, normal first and second heart sounds, a third heart sound, a grade 4/6 pansystolic murmur at the apex, and a grade 2/6 systolic murmur in the tricuspid valve area. Pulmonary auscultation showed bilateral crackles. The patient had tender hepatomegaly with systolic pulsations and bilateral pitting edema. Electrocardiogram showed sinus rhythm and a qR pattern in leads I and aVL. The posteroanterior chest x-ray showed global cardiomegaly and marked pulmonary venous con...