Case Report: Rupture of the cardiac free wall after myocardial infarction confirmed by aortic computed tomography angiography

IntroductionFree wall rupture is a rare complication of myocardial infarction, occurring as early as a few hours after myocardial infarction. It usually happens after transmural myocardial infarction and has a very high mortality rate. The diagnosis of free wall rupture requires echocardiographic ev...

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Main Authors: Jie Liu, Weiqing Chen, Zihan Li, Nan Liu, Cuiying Mao
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-06-01
Series:Frontiers in Cardiovascular Medicine
Subjects:
Online Access:https://www.frontiersin.org/articles/10.3389/fcvm.2025.1502336/full
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author Jie Liu
Weiqing Chen
Zihan Li
Nan Liu
Cuiying Mao
author_facet Jie Liu
Weiqing Chen
Zihan Li
Nan Liu
Cuiying Mao
author_sort Jie Liu
collection DOAJ
description IntroductionFree wall rupture is a rare complication of myocardial infarction, occurring as early as a few hours after myocardial infarction. It usually happens after transmural myocardial infarction and has a very high mortality rate. The diagnosis of free wall rupture requires echocardiographic evidence of pericardial leakage or pericardial tamponade. The patient's cause of death is often attributed to other causes such as cardiac arrhythmia unless determined by open heart surgery or autopsy. Diagnostic tools for post-infarction cardiac free wall rupture are limited to date.Case presentationWe present a case of myocardial infarction in a patient who presented with atypical chest pain. Subsequent coronary angiography revealed small vessel disease, however, the patient's severe clinical presentation was not consistent with small vessel disease. The initial clinical presentation did not rule out aortic dissection, prompting further investigation through aortic computed tomography. This imaging technique revealed a rupture of the free wall of the heart accompanied by a large amount of bloody pericardial effusion. Unfortunately, attempts to puncture and drain the effusion were unsuccessful and the patient eventually succumbed.ConclusionsWhen patients present with more severe clinical manifestations that are not consistent with myocardial infarction, it is important to be alert to the possibility of cardiac rupture in addition to identifying the possibility of aortic dissection. Aortic CTA may be able to confirm the diagnosis of cardiac rupture.
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spelling doaj-art-496503c9d27946f2bdf2559e5c3167162025-08-20T02:10:05ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-06-011210.3389/fcvm.2025.15023361502336Case Report: Rupture of the cardiac free wall after myocardial infarction confirmed by aortic computed tomography angiographyJie LiuWeiqing ChenZihan LiNan LiuCuiying MaoIntroductionFree wall rupture is a rare complication of myocardial infarction, occurring as early as a few hours after myocardial infarction. It usually happens after transmural myocardial infarction and has a very high mortality rate. The diagnosis of free wall rupture requires echocardiographic evidence of pericardial leakage or pericardial tamponade. The patient's cause of death is often attributed to other causes such as cardiac arrhythmia unless determined by open heart surgery or autopsy. Diagnostic tools for post-infarction cardiac free wall rupture are limited to date.Case presentationWe present a case of myocardial infarction in a patient who presented with atypical chest pain. Subsequent coronary angiography revealed small vessel disease, however, the patient's severe clinical presentation was not consistent with small vessel disease. The initial clinical presentation did not rule out aortic dissection, prompting further investigation through aortic computed tomography. This imaging technique revealed a rupture of the free wall of the heart accompanied by a large amount of bloody pericardial effusion. Unfortunately, attempts to puncture and drain the effusion were unsuccessful and the patient eventually succumbed.ConclusionsWhen patients present with more severe clinical manifestations that are not consistent with myocardial infarction, it is important to be alert to the possibility of cardiac rupture in addition to identifying the possibility of aortic dissection. Aortic CTA may be able to confirm the diagnosis of cardiac rupture.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1502336/fullcardiac rupturefree wall ruptureaortic computed tomography angiographydiagnosismyocardial infarction
spellingShingle Jie Liu
Weiqing Chen
Zihan Li
Nan Liu
Cuiying Mao
Case Report: Rupture of the cardiac free wall after myocardial infarction confirmed by aortic computed tomography angiography
Frontiers in Cardiovascular Medicine
cardiac rupture
free wall rupture
aortic computed tomography angiography
diagnosis
myocardial infarction
title Case Report: Rupture of the cardiac free wall after myocardial infarction confirmed by aortic computed tomography angiography
title_full Case Report: Rupture of the cardiac free wall after myocardial infarction confirmed by aortic computed tomography angiography
title_fullStr Case Report: Rupture of the cardiac free wall after myocardial infarction confirmed by aortic computed tomography angiography
title_full_unstemmed Case Report: Rupture of the cardiac free wall after myocardial infarction confirmed by aortic computed tomography angiography
title_short Case Report: Rupture of the cardiac free wall after myocardial infarction confirmed by aortic computed tomography angiography
title_sort case report rupture of the cardiac free wall after myocardial infarction confirmed by aortic computed tomography angiography
topic cardiac rupture
free wall rupture
aortic computed tomography angiography
diagnosis
myocardial infarction
url https://www.frontiersin.org/articles/10.3389/fcvm.2025.1502336/full
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AT zihanli casereportruptureofthecardiacfreewallaftermyocardialinfarctionconfirmedbyaorticcomputedtomographyangiography
AT nanliu casereportruptureofthecardiacfreewallaftermyocardialinfarctionconfirmedbyaorticcomputedtomographyangiography
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