Cardiac compression causing fatal acute ST-segment elevation myocardial infarction

A 71-year-old woman presented 2 weeks after thoracic endovascular repair of a mycotic descending aortic aneurysm. One week after discharge she presented with chest pain and transient lateral ST-segment elevation on electrocardiogram (Figure 1a). Urgent computerized tomography (CT) scanning (Figure 1B) demonstrated no evidence of endovascular leak or aortic dissection. Her symptoms recurred with dramatic lateral ST-segment elevation and there was akinesis of the lateral wall of the left ventricle (LV) on echocardiography. A diagnosis of ST-segment elevation myocardial infarction was made, but emergency coronary angiography showed no flow-limiting stenoses. Cardiac compression secondary to probable haemorrhagic expansion of the aortic aneurysm was diagnosed. She was not considered fit for re-operation and died shortly afterwards. On several occasions, we have seen patients present with an apparent syndrome comprising of (i) severe cardiac chest pain, (ii) dramatic ST-segment elevation, (iii) unobstructed and brisk epicardial coronary artery blood flow, (iv) large LV regional wall motion abnormality and (v) cardiac compression.