Acute Myocardial Infarction Presenting with Sudden Death Owing to Cardiac Rupture

A 74-year-old woman was admitted to our hospital with a clinical diagnosis of angina pectoris. An electrocardiogram performed in the emergency room showed a sinus rhythm and no evidence of myocardial ischemia or infarction. On the 2nd day, the patient experienced persistent protracted chest pain that could not be relieved by sublingual nitroglycerine administration, which was subsequently followed by sudden hemodynamic collapse, loss of consciousness, and apparent electromechanical dissociation a few minutes later. Immediate cardiopulmonary resuscitation was performed. Instantaneous electrocardiography demonstrated acute extensive anterior and inferior myocardial infarction. Two-dimensional echocardiography was performed promptly, which revealed the presence of pericardial effusion and an echo-dense suspected blood clot within the pericardial cavity, as well as diffuse severe hypocontractility of the whole myocardium. Urgent surgical intervention with subxiphoid incision was performed at the bedside of the patient. During the surgery, a large quantity of blood was drained from the pericardial cavity. The patient died soon, prior to being sent to the operation room, because of protracted cardiac standstill. In conclusion, in a patient with acute myocardial infarction who presents with persistent, protracted chest pain and hemodynamic instability, cardiac rupture should be considered and echocardiography should be performed promptly.