Post-MI Free Wall Rupture — EECC MCQ

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HardCoronary Artery DiseasePost-MI Free Wall RuptureEECC

A 60-year-old man experiences chest pain 3 days after anterior MI. He develops sudden hypotension and electromechanical dissociation. Echocardiography shows a large pericardial effusion with LV free wall discontinuity. What is the diagnosis?

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Correct answer: B — LV free wall rupture — a catastrophic mechanical complication of MI requiring emergency surgical repair; most cases are rapidly fatal

LV free wall rupture (FWR) is the most lethal mechanical complication of acute MI, typically occurring 1-5 days post-MI (or later in the reperfusion era). Risk factors include: large transmural infarction, first MI, anterior location, female sex, elderly, and delayed presentation. Acute FWR presents with sudden haemopericardium, tamponade, electromechanical dissociation, and death within minutes. Subacute FWR (contained by pericardial adhesions forming a pseudoaneurysm) may allow time for emergency surgery. Echocardiography showing pericardial effusion with myocardial wall discontinuity is diagnostic. Emergency pericardiocentesis and surgical repair (or patch closure) are life-saving but survival rates remain poor (<50%).

Reference: ESC (2023): Guidelines for the Management of Acute Coronary Syndromes