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Post-MI Free Wall Rupture — RACP Adult Medicine MCQ

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HardCardiologyPost-MI Free Wall RuptureRACP Adult Medicine

A 60-year-old woman with an inferior STEMI treated with PCI 4 days ago develops sudden haemodynamic collapse with pulseless electrical activity. Bedside echo shows a large pericardial effusion with RV diastolic collapse (tamponade physiology) and a free wall rupture seen as an echo-dense mass in the pericardium. What is the most likely complication?

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Correct answer: D — Post-MI free wall rupture (cardiac tamponade)

Sudden haemodynamic collapse with tamponade 3-5 days after MI is free wall rupture — the most lethal mechanical complication (usually rapidly fatal). Risk factors: first MI, anterior wall, elderly, female, delayed reperfusion. Complete rupture → haemopericardium → tamponade → PEA arrest. Treatment: immediate pericardiocentesis (temporising) + emergency surgical repair. Subacute contained rupture (pseudoaneurysm) may present more insidiously with recurrent chest pain.

Reference: CSANZ – 2025 – ACS; ESC 2023