key: cord-0696163-c0505i5h
authors: Kassimis, George; Karagiannidis, Efstratios; Triantafyllou, Konstantinos; Karapanagiotidis, Georgios T.
title: Fatal Post-Infarction Late Left Ventricular Free Wall Rupture in the Era of COVID-19
date: 2020-07-14
journal: JACC Cardiovasc Interv
DOI: 10.1016/j.jcin.2020.07.012
sha: fcf89970d35694814f7941b6bac0bad53df54509
doc_id: 696163
cord_uid: c0505i5h

nan

A 71-year-old woman without a cardiovascular history was transferred from a nearby hospital to our catheterization laboratory in cardiogenic shock on vasopressors following a very late presentation anterior ST-segment elevation myocardial infarction (STEMI) (Figure 1 Admissions for acute MI were significantly reduced during the COVID-19 pandemic worldwide, possibly because of the fear of contagion at the hospital, with a parallel increase in fatality and complication rates [1] . Delayed revascularization in STEMI poses a significant challenge due to re-emergence of rare and often fatal mechanical MI-related complications, as in our patient.

frequently results in death, with in-hospital mortality rates of 57% and 80% in large studies.

It is more common in the anterior and lateral walls and is associated with old age, lack of collateral circulation, or ischemic preconditioning and presentation with first MI, as in our patient. The most frequent presentation is with syncope or pulseless electrical activity and pericardial effusion; however, nearly half of the deaths from cardiac rupture occur as out-ofhospital sudden deaths and never present to the hospital [2, 3] .

Cardiac rupture needs to be ruled out in STEMI patients presenting very late. Prompt recognition of this complication in the cardiac catheterization laboratory using ventriculography is necessary to allow immediate surgical alerting and operation. Even with early diagnosis, mortality remains extremely high. In the COVID-19 era, healthcare providers should continue educating patients to recognize life-threatening cardiovascular symptoms and seek timely care to avoid serious complications. 

Acute coronary syndrome in the time of the COVID-19 pandemic

Temporal trends and outcomes of mechanical complications in patients with acute myocardial infarction

Left Ventricular Free Wall Rupture During Ventriculography