[Rupture of the free wall of the left ventricle as the first manifestation of a myocardial infarct. A clinical case operated on with success].

A case of an undetected myocardial infarction in a patient with diabetes mellitus in which the first clinical sign was a syncope due to rupture of the left ventricular inferior wall is described. Survival was enhanced by a fast diagnosis (aided by the availability of an ECO 2D in the emergency room), by emergency pericardiocentesis with temporary haemodynamic stabilization and by prompt access to the Cardiosurgical Unit. A prompt diagnosis and treatment can allow the survival of patients, even in the extreme case that the ventricular wall rupture represents the first clinical manifestation of the myocardial infarction. The left ventricular free wall rupture in the course of myocardial infarction has a subacute pattern in about 30%, due to various mechanisms such as thrombosis or pericardial adherence over the ruptured wall.