A 59 Year Old Man Presenting With A Complication Following A Myocardial Infarction

A 59-year-old man is hospitalized after suffering a severe myocardial infarction. He is initially
treated with nitrates, β-blockers, and aspirin, and subsequently undergoes cardiac catheterization with placement of two stents. Following the procedure he is hemodynamically stable without recurrence of chest pain. However, 5 days after admission his heart rate is 134/min, blood pressure is 72/35 mm Hg, and respiratory rate is 29/min.
Physical examination reveals distant heart sounds and an elevated jugular venous pressure.
Which of the following complications is most likely causing this patient’s symptoms?

(A) Aneurysm formation
(B) Cardiac arrhythmia
(C) Fibrinous pericarditis
(D) Rupture of the papillary muscle
(E) Rupture of the ventricular free wall

Answer And Discussion: 

The correct answer is E. Rupture of the ventricular free wall

This patient is in shock due to cardiac tamponade secondary to the rupture of the ventricular free wall, which usually occurs 4–10 days after the initial myocardial infarction (MI). It usually presents with sudden shock with signs of cardiac tamponade, such as the hypotension, distant heart sounds, and elevated jugular venous pressure observed in this patient. Survival depends primarily on the rapid recognition of myocardial rupture and the provision of immediate therapy, such as urgent pericardiocentesis or surgery. Unfortunately, this complication of an MI is often fatal.