Research Day

Rupture of Left Ventricular Aneurysm Leading to Hemopericardium and Subsequent Death from Cardiac Tamponade

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BACKGROUND/INTRODUCTION Left ventricular aneurysms (LVAs) are an uncommon but important complication of myocardial infarctions (MIs), taking place in 3-15% of acute MIs. In turn, 90% of MIs involve the obstruction of an atherosclerotic coronary artery. While atherosclerosis is predominantly asymptomatic, occlusion of the arterial vasculature can lead to ischemia and organ-specific clinical manifestations. Amongst other risk factors, untreated mild to moderate hypertension is associated with a 30% risk of atherosclerotic disease. Since 75 million people in the United States suffer from hypertension, and approximately half of them have poor control of their blood pressure, these are relevant diseases to consider in the discussion of LVAs. STUDY PURPOSE This study discusses the role of hypertension and atherosclerosis in predisposing a patient with a myocardial infarct to develop a ruptured left ventricular aneurysm, which ultimately caused his death as a result of a cardiac tamponade due to hemopericardium. CASE REPORT A 55-year old Caucasian male with a history of HTN, alcohol use and tobacco use collapsed on the counter while attempting to grab a cup of coffee at work. All resuscitative efforts failed and he was referred for medical autopsy. The decedent had normal development and build (BMI = 25.8). External examination was unremarkable except for abdominal obesity. Internal examination revealed 500 cc of liquid and clotted blood in the pericardial cavity. A lateral left ventricular wall aneurysm with associated mural thrombus was also noted. A 3x3 area of pericardium was adhered to the underlying endocardium in a location immediately lateral to the aneurysm. The aneurysmal wall ranged from < 1mm to 3 cm in thickness, with a 0.5 cm defect through the aneurysmal wall. Multiple areas of atherosclerosis were noted throughout the coronary vessels. DISCUSSION/CONCLUSION Hypertension and atherosclerotic disease are extremely common medical conditions, frequently unmanaged, and capable of developing into a wide array of conditions, from chronic ones with an insidious course to acute exacerbations with life-threatening consequences, including LVAs. Cardiac catheterization is the gold standard of diagnosis of LVA, but echocardiography is also a highly sensitive and specific detection technique. While small LVAs can be targeted with pharmaceutical treatment, larger LVAs may require surgical resection, and even then, only under certain circumstances. Managing risk factors and screening patients with pertinent medical history and physical exam findings is therefore an essential component in the prevention of LVA complications or death.

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