A 66-year-old man comes to the emergency department because of a 1-day history of chest pain, palpitations, and dyspnea on exertion. He had a similar episode 3 days ago and was diagnosed with an acute myocardial infarction. He was admitted and a percutaneous transluminal coronary angioplasty was successfully performed that day. A fractional flow reserve test during the procedure showed complete resolution of the stenosis. Cardiac troponin concentrations were elevated. Other laboratory tests including serum glucose, lipids, and blood count were within normal limits. He was discharged the day after the procedure on a drug regimen of aspirin, simvastatin, and isosorbide dinitrate. At the time of discharge, he had no chest pain or dyspnea. Presently, his vitals are normal and ECG at rest shows new T-wave inversion in leads II, III, and aVF. Physical examination shows raised jugular venous pressure, no heart murmurs, and clear lungs. He rapidly loses consciousness and becomes pulseless, and the subsequent resuscitation attempt is ineffective. Which of the following most likely contributed to this patient's death?

Question

A 66-year-old man comes to the emergency department because of a 1-day history of chest pain, palpitations, and dyspnea on exertion. He had a similar episode 3 days ago and was diagnosed with an acute myocardial infarction. He was admitted and a percutaneous transluminal coronary angioplasty was successfully performed that day. A fractional flow reserve test during the procedure showed complete resolution of the stenosis. Cardiac troponin concentrations were elevated. Other laboratory tests including serum glucose, lipids, and blood count were within normal limits. He was discharged the day after the procedure on a drug regimen of aspirin, simvastatin, and isosorbide dinitrate. At the time of discharge, he had no chest pain or dyspnea. Presently, his vitals are normal and ECG at rest shows new T-wave inversion in leads II, III, and aVF. Physical examination shows raised jugular venous pressure, no heart murmurs, and clear lungs.  He rapidly loses consciousness and becomes pulseless, and the subsequent resuscitation attempt is ineffective.  Which of the following most likely contributed to this patient's death?

Quizplus · Accepted Answer

Eductional Objective: Left ventricular free wall rupture is a mechanical complication that can occur within 5 days or up to 2 weeks following transmural (ST-elevation) myocardial infarction.  Patients usually develop acute cardiac tamponade with hypotension and obstructive shock that rapidly leads to cardiac arrest.

A 66-Year-Old Man Comes to the Emergency Department Because of a 1-Day