Management of a complicated chest pain

We describe the management of a subacute heart rupture complicat-ing a subacute miocardial infarction presenting with ST-segment ele-vation in a patient at high risk for cardiovascular disease. The patient,woman of 53 years old, obese, hyperlipidemic and abitual smoker,was admitted to the Emergency Room for chest pain lasting for two hours at the moment of the first evaluation. She presented featuresof cardiogenic shock. Electrocardiographic finds and laboratory testsshowed the clear picture of myocardial infarction. The first approachwas completed with echocardiographic evaluation which confirmedakinesia of the inferior wall, dyskinetic movement of septum, reducedejection fraction and tamponade likely due to left ventriculi fissuration.She was suddenly shifted to the main near hospital where, once evi-denced a bivasal coronaropathy, she was treated with coronary bypassand heart wall reparation through Dacron patch in a one-time surgery.After one week in intensive care unit the patient was again committedto our attention and definitively discharged after other eleven days. Atlast evaluation after one month the woman is still in good clinical con-ditions and maintains stable hemodynamic parameters.