This case report highlights that left ventricular free wall rupture, though very rare, can occur as a fatal complication in patients with transient left ventricular apical ballooning, particularly those with persistent ST-segment elevation.
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LV free wall rupture may cause fatal tamponade in apical ballooning with persistent ST elevation; one case leaves open need for intensified monitoring.
A 79-year-old woman presented with chest pain. Her symptoms, combined with the results of an electrocardiogram, echocardiogram and laboratory investigations were compatible with an extensive acute anterior myocardial infarction. However, emergency coronary angiography showed no stenotic lesion in any coronary artery, but left ventriculography revealed apical ballooning akinesis and basal hyperkinesis and she was diagnosed as having transient left ventricular apical ballooning. After 7 days, she suddenly went into cardiopulmonary arrest because of cardiac tamponade. The autopsy revealed a free wall rupture. Generally, the prognosis in transient left ventricular apical ballooning is good; left ventricular free wall rupture is very rare.
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Ohara et al. (2005) studied this question.
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