Unusual presentation of left ventricular rupture

BMJ Case Rep. 2020 Feb 2;13(1):e231680. doi: 10.1136/bcr-2019-231680.

Abstract

We describe a case of 49-year-old man who presented with chest pain and was diagnosed with non-ST elevation myocardial infarction. Transthoracic echocardiogram (TTE) showed severe global hypokinesis of left ventricle with ejection fraction of 25%-30%. Left heart catheterisation showed severe right coronary stenosis and focal 60%-70% distal left anterior descending artery stenosis. Cardiac MRI (CMR) was done for evaluation of viability which showed a large pseudoaneurysm which was missed on TTE and left ventriculogram. Our case demonstrates the increasing importance of cardiac MRI in the diagnosis of left ventricular pseudoaneurysm. In our case left ventricular pseudoaneurysm was missed on TTE and left ventriculogram. It was diagnosed on CMR which was ordered for evaluation of myocardium viability.

Keywords: clinical diagnostic tests; heart failure; ischaemic heart disease; radiology (diagnostics).

Publication types

  • Case Reports

MeSH terms

  • Aneurysm, False / diagnostic imaging*
  • Aneurysm, False / etiology
  • Aneurysm, False / surgery
  • Cardiac Imaging Techniques
  • Chest Pain / etiology
  • Coronary Stenosis / complications
  • Coronary Stenosis / diagnostic imaging*
  • Coronary Stenosis / surgery
  • Diagnosis, Differential
  • Echocardiography
  • Electrocardiography
  • Heart Aneurysm / diagnostic imaging*
  • Heart Aneurysm / etiology
  • Heart Aneurysm / surgery
  • Heart Ventricles / diagnostic imaging*
  • Heart Ventricles / surgery
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / diagnostic imaging*
  • Myocardial Infarction / surgery
  • Rupture, Spontaneous / diagnostic imaging
  • Treatment Outcome