case_images: PMC10883737_01
case_images: (a) 2D TTE colour Doppler (CFD) echocardiography parasternal short axis (PSAX) view showing LV rupture at the level of the inferior wall with communication between LV and pericardial space (white arrow); (b) 2D TTE apical 4 chamber (A4C) view at presentation showing global large pericardial effusion with clot; (c) coronary angiogram showing occluded dominant distal left circumflex artery (black arrow).
case_images: CRIC2024-3908939.001.jpg
case_images: PMC10883737_01_CRIC2024-3908939.001.jpg
case_images: fig1
case_images: On arrival at the hospital, he was haemodynamically unstable with a blood pressure of 63/48 mmHg. 12-lead electrocardiogram showed ST-segment elevation in inferior leads with established Q waves consistent with late presenting inferior ST-elevation MI (Supplementary Figure 1). A bedside echocardiogram showed a moderately impaired ventricle with an ejection fraction of 40% and suspected LV wall rupture at the apical inferior wall with a moderate-size pericardial effusion mainly around the LV apex with clots (Figures 1(a) and 1(b); Supplementary video 1-3). Following discussion with cardiac surgeons, a coronary angiogram was performed which showed an occluded dominant distal left circumflex artery (Figure 1(c)) and confirmed that this is likely an ischaemic ventricular rupture.
case_images: Postsurgery 2D echocardiography. (a) Parasternal short axis view and (b) apical 4 chamber view.
case_images: CRIC2024-3908939.002.jpg
case_images: PMC10883737_01_CRIC2024-3908939.002.jpg
case_images: fig2
case_images: TTE confirmed resolution of pericardial effusion and repair of the LV wall (Figure 2; Supplementary Video 4, 5; Supplementary Figure 2). The patient's postoperative course was uneventful, and he was subsequently discharged home.