• Images in cardiology

A 71 year old woman with a two hour history of chest pain and ST segment elevation in leads V1–V4 was admitted to our hospital with the diagnosis of acute myocardial infarction and treated with tissue plasminogen activator. Forty eight hours after admission, the patient presented sudden transient hypotension without other symptoms. Transthoracic echocardiography, performed immediately after the onset of hypotension, showed a small amount of pericardial effusion. Left ventricular angiography showed a digital false aneurysm (below left) in the left anterior ventricular wall. In the operating room 200 ml of haemopericardial effusion were evacuated and left ventricular rupture was confirmed. The patient underwent simple patch covering of the wall rupture (below right) and left anterior descending artery bypass grafting. The patient returned to normal activity.