A 60-year-old man develops sudden loss of consciousness and is found to have pulseless electrical activity on day 4 after a large anterior STEMI. Bedside echocardiography shows a large pericardial effusion with right ventricular diastolic collapse. Which complication has most likely occurred?

• A Ventricular septal rupture
• B Papillary muscle rupture
• C Left ventricular free wall rupture ✓
• D Tension pneumothorax

Explanation

Left ventricular free wall rupture typically occurs 3 to 5 days post-MI and presents with electromechanical dissociation (pulseless electrical activity) and tamponade. It is the most common cause of early death in STEMI patients who survive the initial event. VSD causes a loud holosystolic murmur. Papillary muscle rupture causes acute mitral regurgitation with a new murmur.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.