# Post-infarction Left Ventricular Free Wall Rupture Diagnosed by Contrast-Enhanced Computed Tomography: A Case Report

## TL;DR

A 70-year-old woman with heart attack symptoms was diagnosed with a rare heart wall rupture using CT scans, leading to successful surgery.

## Contribution

Demonstrates the utility of contrast-enhanced CT in diagnosing left ventricular free wall rupture in a complex clinical scenario.

## Key findings

- Contrast-enhanced CT confirmed left ventricular free wall rupture in a patient with altered consciousness and ST-elevation myocardial infarction.
- Successful emergent surgical repair was performed without long-term complications.
- CT imaging provided a definitive and early diagnosis of a life-threatening cardiac complication.

## Abstract

A 70-year-old Japanese woman with hypertension, dyslipidemia, and diabetes mellitus complained of abdominal discomfort and vomiting and was brought to our emergency department by ambulance two days later with impaired consciousness. Her vital signs suggested shock with a heart rate of 120 bpm. Electrocardiogram and initial transthoracic echocardiography suggested an inferior wall ST-elevation myocardial infarction, but the altered consciousness was inconsistent. Contrast-enhanced computed tomography was urgently performed to further clarify the cause. It revealed pericardial effusion and apparent extravasation from the left ventricular wall, confirming the early definitive diagnosis of left ventricular free wall rupture. The patient underwent successful emergent surgical repair without sequelae. Differential diagnosis of left ventricular free wall rupture is important in patients with ST-elevation myocardial infarction and impaired consciousness. Contrast-enhanced computed tomography allows early diagnosis and treatment of this life-threatening complication.