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. 2019 Feb 23;11(1):e011156.
doi: 10.1136/heartasia-2018-011156. eCollection 2019.

Peculiar mechanical complication of myocardial infarction

Pratheesh George Mathen  1 , Gopal Chandra Ghosh  1 , Viji Samuel Thomson  1   1
Affiliations

Peculiar mechanical complication of myocardial infarction

Pratheesh George Mathen et al. Heart Asia. .

Abstract

A 58-year-old man presented to the chest pain unit with crescendo angina over 24 hours and worsening dyspnoea of 10 hours duration. He was a known diabetic and hypertensive on regular treatment for 10 years and a habitual smoker with over 15 pack-years smoking duration. Examination revealed a profusely diaphoretic and dyspnoeic (respiratory rate of 45/min) individual with a blood pressure of 100/60 mm Hg and heart rate of 124 beats/min. He was hypoxic and his oxygen saturation in the ambient air was 64%. His jugular venous pressure was elevated with a prominent V wave. Cardiovascular examination revealed a harsh grade IV/VI systolic murmur over the lower left parasternal border. There were bilateral extensive crepitations heard over the lung fields. ECG on admission revealed presence of Q wave and ST elevation in leads II and III, aVF with ST depression in I and aVL. X-ray chest showed normal cardiac shadow and features of grade III pulmonary venous hypertension. Transthoracic echocardiography is shown in figure 1.Figure 1Transthoracic echocardiogram short axis view at mid cavity level, 2D (A) and colour Doppler (B) image.

Question: What is the most likely diagnosis?A. Left ventricular (LV) true aneurysmB. LV pseudoaneurysmC. LV pseudo-pseudoaneurysmD. Ventricular septal rupture (VSR)E. LV free wall rupture.

Keywords: STEMI; acute coronary syndrome; transthoracic.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Transthoracic echocardiogram short axis view at mid cavity level, 2D (A) and colour Doppler (B) image.
Figure 2
Figure 2
(A) Transthoracic echocardiogram short axis view showing the pseudopseudoaneurysm (PsPsA), LV (Left Ventricle) communicating into the aneurysm through a narrow neck and finally rupturing into the RV (Right Ventricle). Yellow dotted line indicates the aneurysm wall formed by septal myocardium. Red dotted lines indicate the aneurysm wall formed by pericardium and thin layer of myocardium. (B) Colour Doppler image for comparision. LV, left ventricle; RV, right ventricle; PsPsA, pseudo-pseudoneurysm.
See this image and copyright information in PMC

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References

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