Left Ventricular Rupture in Transmural Myocardial Infarction Without Enzymatic or Electric Disturbances: Medico-legal Implications

Background: The early and accurate diagnosis of acute myocardial infarction may be a challenging task for doctors in the emergency room. The patient’s history, electrocardiographic and cardiac markers data are sometimes non diagnostic and misleading which may lead to death. In this case, physician’s responsibility may be engaged. Case report: A 48-year-old man was admitted in the Emergency Department because of chest pain. Exploration (Percritical ECG, enzymatic levels and transthoracic echocardiogram) did not show any abnormality. He received a symptomatic treatment and was allowed to return home. The patient was confined to bed during his stay at home because of persisting chest pain. Two days later, he presented syncope and arrived dead to hospital. At autopsy, an abundant hemopericardium made by coagulated blood was noted, associated with an obstruction of the circumflex of about 90% of its light. A rupture of the myocardium was repaired in the lateral wall of left ventricle, surrounded by a semi recent infarction. Discussion: The peculiarity of this case is the difficulty of the diagnosis of the myocardial infarction because of the normality of the enzymatic assessment and the absence of electric modifications during the crisis and two hours later. Misdiagnosed cases can lead health professionals to legal suits. The claims about diagnostic error can be usually subject to trials in both of penal judgment and compensation trial.