Ventricular free wall rupture complicating STEMI most commonly occurs at what time interval after the index infarction?

• A Within the first 2 hours
• B 3–5 days post-MI ✓
• C Day 1 only
• D 2–3 weeks post-MI

Explanation

Free wall rupture (FWR) after STEMI classically occurs 3–5 days post-infarction, corresponding to the phase of maximal neutrophilic infiltration and myocardial softening before fibrosis is established. It presents as sudden haemodynamic collapse with electromechanical dissociation (PEA). Early reperfusion with primary PCI has reduced but not eliminated this risk. Late rupture (days 5–14) is less common. FWR at less than 24 hours occurs in fewer than 20% of cases.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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