A Silent Dissection Complicating Myocardial Infarction: A Case Report

A Left Ventricular (LV) pseudoaneurysm develops when free myocardial wall rupture is contained by an adherent layer of overlying pericardium and scar tissue. It is a rare mechanical complication seen in 0.2% of patients post Myocardial Infarction (MI). Furthermore, it remains a challenge to diagnose...

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Main Authors: Adithya Shelley, Akshat Sharma, Jostol Pinto
Format: Article
Language:English
Published: JCDR Research and Publications Private Limited 2025-03-01
Series:Journal of Clinical and Diagnostic Research
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Online Access:https://jcdr.net/articles/PDF/20793/75635_CE[Ra1]_F(SL)_PF1(RI_SS)_PFA(IS)_PFA(IS)_PN(IS).pdf
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author Adithya Shelley
Akshat Sharma
Jostol Pinto
author_facet Adithya Shelley
Akshat Sharma
Jostol Pinto
author_sort Adithya Shelley
collection DOAJ
description A Left Ventricular (LV) pseudoaneurysm develops when free myocardial wall rupture is contained by an adherent layer of overlying pericardium and scar tissue. It is a rare mechanical complication seen in 0.2% of patients post Myocardial Infarction (MI). Furthermore, it remains a challenge to diagnose and differentiate it from a true aneurysm due to overlapping clinical presentations and echocardiographic findings. A 40-year-old male patient presented with ST Elevation Myocardial Infarction (STEMI) and received guideline directed management. However, he was later found to have a pansystolic murmur at the apex and an early diastolic murmur over the left lower sternal border (to and fro murmur) on auscultation. An echocardiogram had subsequently revealed a dissecting pseudoaneurysm of the left ventricle and Contrast-enhanced Computed Tomography (CECT) confirmed the presence of an anterior dissecting pseudoaneurysm. This is an atypical presentation of a niche post MI complication due to its asymptomatic presentation, atypical location and unique anatomy despite prompt revascularisation. Furthermore, the authors emphasise the importance of cardiac auscultation on a day-to-day basis and high index of suspicion to ensure early diagnosis and management of such a silent, calamitous complication.
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spelling doaj-art-ed36e0861dc74ed7809686edba1649e32025-08-20T02:12:41ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2025-03-01193131510.7860/JCDR/2025/75635.20793A Silent Dissection Complicating Myocardial Infarction: A Case ReportAdithya Shelley0Akshat Sharma1Jostol Pinto2Department of Cardiology, Father Muller Medical College, Mangaluru, Karnataka, India.Department of Cardiology, Father Muller Medical College, Mangaluru, Karnataka, India.Associate Professor, Department of Cardiology, Father Muller Medical College, Mangaluru, Karnataka, India.A Left Ventricular (LV) pseudoaneurysm develops when free myocardial wall rupture is contained by an adherent layer of overlying pericardium and scar tissue. It is a rare mechanical complication seen in 0.2% of patients post Myocardial Infarction (MI). Furthermore, it remains a challenge to diagnose and differentiate it from a true aneurysm due to overlapping clinical presentations and echocardiographic findings. A 40-year-old male patient presented with ST Elevation Myocardial Infarction (STEMI) and received guideline directed management. However, he was later found to have a pansystolic murmur at the apex and an early diastolic murmur over the left lower sternal border (to and fro murmur) on auscultation. An echocardiogram had subsequently revealed a dissecting pseudoaneurysm of the left ventricle and Contrast-enhanced Computed Tomography (CECT) confirmed the presence of an anterior dissecting pseudoaneurysm. This is an atypical presentation of a niche post MI complication due to its asymptomatic presentation, atypical location and unique anatomy despite prompt revascularisation. Furthermore, the authors emphasise the importance of cardiac auscultation on a day-to-day basis and high index of suspicion to ensure early diagnosis and management of such a silent, calamitous complication.https://jcdr.net/articles/PDF/20793/75635_CE[Ra1]_F(SL)_PF1(RI_SS)_PFA(IS)_PFA(IS)_PN(IS).pdfechocardiogramleft ventricular pseudoaneurysmtrue aneurysm
spellingShingle Adithya Shelley
Akshat Sharma
Jostol Pinto
A Silent Dissection Complicating Myocardial Infarction: A Case Report
Journal of Clinical and Diagnostic Research
echocardiogram
left ventricular pseudoaneurysm
true aneurysm
title A Silent Dissection Complicating Myocardial Infarction: A Case Report
title_full A Silent Dissection Complicating Myocardial Infarction: A Case Report
title_fullStr A Silent Dissection Complicating Myocardial Infarction: A Case Report
title_full_unstemmed A Silent Dissection Complicating Myocardial Infarction: A Case Report
title_short A Silent Dissection Complicating Myocardial Infarction: A Case Report
title_sort silent dissection complicating myocardial infarction a case report
topic echocardiogram
left ventricular pseudoaneurysm
true aneurysm
url https://jcdr.net/articles/PDF/20793/75635_CE[Ra1]_F(SL)_PF1(RI_SS)_PFA(IS)_PFA(IS)_PN(IS).pdf
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