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A 76 year old man was brought in after a syncope. His past medical history included radiotherapy for lung cancer. Upon arrival, he was pale, diaphoretic, and complained of shortness of breath. He quickly became haemodynamically unstable. The initial ECG showed inferior ST segment elevation while a transthoracic echocardiogram revealed a pericardial effusion.
After stabilising his condition, transoesophageal echocardiography documented a circumferential pericardial effusion and an associated hypokinetic inferior wall. Further evaluation allowed visualisation of a myocardial rupture near the apex (panel A) while Doppler colour flow imaging exposed flow from two sites with each systole (panels B and C).
The patient underwent emergency heart surgery and a 1.2 cm rupture caused by myocardial infarction was found near the apical posterior wall. The patient had an unremarkable postoperative period and was well upon follow up one month later.