Introduction: Left ventricular rupture accompanying acute myocardial infarction (STEMI) is uncommon. Rupture typically occurs several days following acute infarction and in out-of-hospital settings is almost always fatal on-scene.
Methods:A 67-year-old diabetic hypertensive male arrested in presence of police with a defibrillator. Prior to losing consciousness the patient said “I am going to die.” He then became pulseless and apneic. The initial rhythm was atrial flutter at 150/min (Figure).
Results: Resuscitation restored a pulse. Admission ECG confirmed inferior STEMI. A 100% occlusion of the right coronary artery with thrombus was observed, accompanied by basal inferior LV wall rupture with hemopericardium. Coronary grafting and repair of the rupture were followed by extracorporeal membrane oxygenation (ECMO). Despite aggressive care he expired one week later.
Conclusions: Acute LV rupture is a very uncommon accompaniment of STEMI. It has been reported in only 13% of patients. This patient presented with a PEA arrest in atrial flutter, STEMI, and acute LV rupture. His ominous prediction “I am going to die” was fulfilled several days later.