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CardioNerds (Amit and Dan) join Dr. Maria Pabon (cardiology fellow), Dr. Kevin Bersell (cardiology fellow), Dr. Saad Sultan Ghumman (interventional cardiology fellow), and Dr. Rhanderson Cardoso (cardiovascular imaging fellow) from Brigham and Women\u2019s Hospital. Together, they explore a complex case of STEMI that was further complicated by ventricular free wall rupture. Additionally, Dr. Ajar Kochar, Program Director for Interventional Cardiology at Brigham and Women's Hospital, provides an insightful "ECPR" segment, adding a unique perspective to the case. Audio editing by\xa0CardioNerds Academy Intern,\xa0student doctor Chelsea Amo Tweneboah.\n\n\n\nThis is the case of a patient who presented with STEMI and was found to have a moderate pericardial effusion with echogenic material within the pericardial space concerning for thrombus. Urgent CTA/CT surgery was engaged due to concern for dissection, but no evidence of dissection, rupture or intramural hematoma was found. The patient underwent an urgent pericardiocentesis which yielded 350cc of hemorrhagic fluid, leading to an improvement in hemodynamic status. A coronary angiogram was performed which showed a 100% thrombotic occlusion of OM 1, the culprit lesion for the STEMI. Due to the possibility of a delayed STEMI and high suspicion for mechanical complication of MI, aspirin and IV cangrelor were chosen as the preferred antiplatelet strategy. However, cangrelor was held and cardiac surgery was consulted, as LV free wall rupture was suspected. The patient underwent urgent repair of the LV free wall rupture, with an uneventful post-op recovery and discharge on day 8 to cardiac rehab.\n\n\n\nCardioNerds is collaborating with\xa0Radcliffe Cardiology\xa0and\xa0US Cardiology Review journal (USC)\xa0for a \u2018call for cases\u2019, with the intention to co-publish high impact cardiovascular case reports, subject to double-blind peer review. Case Reports that are accepted in USC journal and published as the version of record (VOR), will also be indexed in Scopus and the Directory of Open Access Journals (DOAJ).\n\n\n\n\n\n\n\n\n\n\n\nCardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll\n\n\n\n\n\nCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!\n\n\n\n\n\n\nCase Media\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPearls - When Infarction Brings the Walls Down - Brigham and Women\u2019s Hospital\n\n\n\n\nIn the era of primary PCI, mechanical complications of MI are relatively rare.\n\n\n\nTimely recognition using multi-modality imaging and prompt surgical intervention can result in favorable outcomes.\n\n\n\nAn approach that involves a Heart Team can be advantageous in optimizing outcomes in such complex cases.\n\n\n\n\nShow Notes - When Infarction Brings the Walls Down - Brigham and Women\u2019s Hospital\n\n\n\n\nIncidence of post AMI LV free wall rupture: \n\n0.1-1%\n\n\n\n\n\nRisk factors for LV Free wall Rupture:\n\nOlder age\n\n\n\nFemale sex\n\n\n\nPrior HTN\n\n\n\n1st lateral or Anterior Wall MI\n\n\n\n\n\nProtective factors towards free wall rupture:\n\nLV hypertrophy\n\n\n\nCHF\n\n\n\nHx of prior infarcts\n\n\n\nChronic ischemic heart disease\n\n\n\nEarly use of beta blockers post MI\n\n\n\nTimely intervention\n\n\n\n\n\nIncidence of Mortality associated with mechanical rupture related to AMI: \n\n8-10%\n\n\n\n\n\nWhen to suspect a mechanical complication of AMI:\n\nAMI with shock/hypotension\n\n\n\nNew murmur\n\n\n\nNew pericardial effusion > 10mm on bedside echo\n\n\n\n\n\nOther etiologies that can cause free wall rupture:\n\nTrauma\n\n\n\nCardiac infection\n\n\n\nAortic dissection\n\n\n\nCardiac tumors\n\n\n\nInfiltrative diseases\n\n\n\nIatrogenic from PCI or surgical procedures\n\n\n\n\n\n\nReferences - When Infarction Brings the Walls Down - Brigham and Women\u2019s Hospital\n\n\n\n\nVarghese S, Ohlow MA. Left ventricular free wall rupture in myocardial infarction: A retrospective analysis from a single tertiary center. JRSM Cardiovasc Dis. 2019 Jan-Dec;8:2048004019896692. doi: 10.1177/2048004019896692. PMID: 31970072.\n\n\n\nPineda-De Paz, D.O.,