Milking effect in coronary angiography due to left ventricular free wall rupture

Left ventricular free wall rupture is a potentially fatal complication of myocardial infarction. The prompt diagnosis of this condition is of high clinical importance. The patient, a 45-year-old man, with a history of hypertension and symptoms of chest pain and shock status, was admitted in the emergency department. Due to electrocardiographic changes consistent with myocardial infarction, he was transferred to cath lab for primary angioplasty (PCI). The initial echocardiographic assessment did not indicate any evidence of mechanical complication of myocardial infarction. Clinical condition of the patient did not improve after primary PCI. During the primary PCI, diagnosis of milking effect in the coronary arteries engendered suspicion of potential mechanical complications of myocardial infarction. Re-evaluation by echocardiography revealed left ventricular free wall rupture. Observing milking effect in angiography can be a result of mechanical complications of myocardial infarction.

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Left ventricular free-wall rupture, a potentially lethal mechanical complication of acute myocardial infarction: an unusual and illustrative case report

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-1063-x ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Dulman O. Pineda-De Paz ◽

Jorge E. Hernández-del Rio ◽

Christian González-Padilla ◽

Ramón M. Esturau-Santaló ◽

Joseph Romero-Palafox ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Case Report ◽

Left Ventricular ◽

Ventricular Free Wall ◽

Illustrative Case ◽

Mechanical Complication ◽

Free Wall ◽

Left Ventricular Free Wall ◽

Free Wall Rupture

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Left Ventricular Free Wall Rupture as a Result of Delayed Presentation of an Inferior ST-Elevation Myocardial Infarction Due to Fear of COVID-19

10.21203/rs.3.rs-127862/v1 ◽

2020 ◽

Author(s):

George Hany Nasr ◽

Diana Glovaci ◽

Andrew Mikhail ◽

Steven Sinfield ◽

Kevin Chen ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiac Arrest ◽

Left Ventricular ◽

Ventricular Free Wall ◽

Myocardial Infarctions ◽

Medical Setting ◽

Free Wall ◽

Left Ventricular Free Wall ◽

Free Wall Rupture ◽

Mechanical Complications

Abstract BackgroundLeft ventricular free wall rupture (LVFWR) is a rare complication after myocardial infarction and usually occurs one to four days after the infarct. Over the past decade, the overall incidence of LVFWR has decreased given the advancements in reperfusion therapies. However, during the COVID-19 pandemic, there has been a significant delay in hospital presentation of patients suffering myocardial infarctions, leading to a higher incidence of mechanical complications from myocardial infarctions such as LVFWR.Case PresentationWe present a case in which a patient suffered a LVFWR as a mechanical complication from myocardial infarction due to delay in seeking care over fear of contracting COVID-19 from the medical setting. The patient had been having chest pain for a few days but refused to seek medical care due to fear of contracting COVID-19 from within the medical setting. He eventually suffered a cardiac arrest at home from a massive inferior myocardial infarction and found to be in cardiac tamponade from a left ventricular perforation. He was emergently taken to the operating room to attempt to repair the rupture but he ultimately expired on the operating table.ConclusionsThe occurrence of LVFWR has been on a more significant rise over the course of the COVID-19 pandemic as patients delay seeking care over fear of contracting COVID-19 from within the medical setting. Clinicians should consider mechanical complications of MI when patients present as an out-of-hospital cardiac arrest, particularly during the COVID-19 pandemic, as delay in seeking care is often the exacerbating factor.

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Left ventricular free wall rupture as a result of delayed presentation of an inferior ST-elevation myocardial infarction due to fear of COVID-19: case report

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01495-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

George H. Nasr ◽

Diana Glovaci ◽

Andrew Mikhail ◽

Steven Sinfield ◽

Kevin Chen ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiac Arrest ◽

Left Ventricular ◽

Ventricular Free Wall ◽

Myocardial Infarctions ◽

Medical Setting ◽

Free Wall ◽

Left Ventricular Free Wall ◽

Free Wall Rupture ◽

Mechanical Complications

Abstract Background Left ventricular free wall rupture (LVFWR) is a rare complication after myocardial infarction and usually occurs 1 to 4 days after the infarct. Over the past decade, the overall incidence of LVFWR has decreased given the advancements in reperfusion therapies. However, during the COVID-19 pandemic, there has been a significant delay in hospital presentation of patients suffering myocardial infarctions, leading to a higher incidence of mechanical complications from myocardial infarctions such as LVFWR. Case presentation We present a case in which a patient suffered a LVFWR as a mechanical complication from myocardial infarction due to delay in seeking care over fear of contracting COVID-19 from the medical setting. The patient had been having chest pain for a few days but refused to seek medical care due to fear of contracting COVID-19 from within the medical setting. He eventually suffered a cardiac arrest at home from a massive inferior myocardial infarction and found to be in cardiac tamponade from a left ventricular perforation. He was emergently taken to the operating room to attempt to repair the rupture but he ultimately expired on the operating table. Conclusions The occurrence of LVFWR has been on a more significant rise over the course of the COVID-19 pandemic as patients delay seeking care over fear of contracting COVID-19 from within the medical setting. Clinicians should consider mechanical complications of MI when patients present as an out-of-hospital cardiac arrest, particularly during the COVID-19 pandemic, as delay in seeking care is often the exacerbating factor.

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