Abstract
An 81-year-old man was admitted to the hospital because of decreased level of consciousness.
He had bradycardia (27 beats/min). Electrocardiography showed ST-segment elevation
in leads II, III, and aVF and ST-segment depression in leads aVL, V1. Transthoracic
echocardiography (TTE) visualized reduced motion of the left ventricular (LV) inferior
wall and right ventricular (RV) free wall. Coronary angiography revealed occlusion
of the right coronary artery. A primary percutaneous coronary intervention was successfully
performed with temporary pacemaker backup. On the third day, the sinus rhythm recovered,
and the temporary pacemaker was removed. On the fifth day, a sudden cardiac arrest
occurred. Extracorporeal cardiopulmonary resuscitation was performed. TTE showed a
high-echoic effusion around the right ventricle, indicating a hematoma. The drainage
was ineffective. He died on the eighth day. An autopsy showed the infarcted lesion
and an intramural hematoma in the RV. However, no definite perforation of the myocardium
was detected. The hematoma extended to the epicardium surface, indicative of oozing-type
RV rupture induced by RV infarction. The oozing-type rupture induced by RV infarction
might develop asymptomatically without influence on the vital signs of the patient.
Frequent echocardiographic evaluation is essential in cases of RV infarction taking
care of silent oozing-type rupture.
Learning objective
Inferior left ventricular infarction sometimes complicates right ventricular (RV)
infarction. The typical manifestations of RV infarction include low blood pressure,
low cardiac output, and elevated right atrium pressure. Although the frequency is
low, fatal complications of oozing-type RV rupture might progress asymptomatically.
Frequent echocardiographic screening is necessary to detect them.
Keywords
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Article info
Publication history
Published online: August 27, 2022
Accepted:
August 3,
2022
Received in revised form:
July 16,
2022
Received:
February 24,
2022
Identification
Copyright
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
