A 55-year-old man dies 4 days after an anterior MI. Autopsy reveals a soft, yellowish area in the anterior wall with neutrophilic infiltrate. Which structural complication is MOST likely to occur at this time?
- A Fibrinous pericarditis (Dressler's syndrome)
- B Left ventricular aneurysm with mural thrombus
- C Free wall rupture leading to cardiac tamponade ✓
- D Papillary muscle fibrosis causing mitral regurgitation
Correct answer: C. Free wall rupture leading to cardiac tamponade
Explanation
The peak risk for myocardial free wall rupture is 3–5 days post-MI, coinciding with maximum softening of necrotic myocardium due to neutrophil-mediated proteolytic digestion (the 'yellow softening' stage). This can cause hemopericardium and acute cardiac tamponade. LV aneurysm occurs weeks to months later from fibrous replacement; Dressler's syndrome appears weeks after MI; papillary muscle fibrosis is a late complication.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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