Six days after being admitted to the intensive care unit because of acute myocardial infarction, an 80-year-old man is evaluated for acute substernal chest pain and dyspnea. Coronary angiography on admission showed an occlusion in the left anterior descending artery, and a drug-eluting stent was placed successfully. The patient has a history of hypertension and type 2 diabetes mellitus. Current medications include aspirin, clopidogrel, metoprolol, lisinopril, and atorvastatin. His temperature is 37.2°C (99°F), pulse is 112/min, respirations are 21/min, and blood pressure is 72/50 mm Hg. During evaluation, the patient becomes unresponsive and goes into cardiac arrest. Despite appropriate lifesaving measures, there is no return of spontaneous circulation and she is pronounced dead. Autopsy examination is performed, and the myocardial findings are shown in the image below. Which of the following most likely predisposed this patient to the observed cardiac findings?

Question

Six days after being admitted to the intensive care unit because of acute myocardial infarction, an 80-year-old man is evaluated for acute substernal chest pain and dyspnea. Coronary angiography on admission showed an occlusion in the left anterior descending artery, and a drug-eluting stent was placed successfully. The patient has a history of hypertension and type 2 diabetes mellitus. Current medications include aspirin, clopidogrel, metoprolol, lisinopril, and atorvastatin. His temperature is 37.2°C (99°F), pulse is 112/min, respirations are 21/min, and blood pressure is 72/50 mm Hg. During evaluation, the patient becomes unresponsive and goes into cardiac arrest.  Despite appropriate lifesaving measures, there is no return of spontaneous circulation and she is pronounced dead.  Autopsy examination is performed, and the myocardial findings are shown in the image below.  Which of the following most likely predisposed this patient to the observed cardiac findings?

Quizplus · Accepted Answer

Eductional Objective: Left ventricular (LV) free-wall rupture is an uncommon but devastating mechanical complication of transmural myocardial infarction that occurs up to 2 weeks following the event (frequently within 5 days).  Rupture leads to cardiac tamponade that causes hypotension and shock with rapid progression to cardiac arrest.  Autopsy typically reveals a slitlike tear at the site of infarction in the LV wall.

Six Days After Being Admitted to the Intensive Care Unit