A man in his 50s with right coronary artery posterolateral branch occlusion experienced an in-hospital cardiac arrest. A bedside transthoracic echocardiogram (TTE) demonstrated a large pericardial effusion with tamponade physiology (subcostal view) as well as large inferior wall aneurysm on TTE (apical 2-chamber view) and left ventriculography. He was treated with extracorporeal membrane oxygenation (ECMO) and transferred for emergent surgery. Intraoperatively, perforation of a 4 × 8 × 4-cm aneurysm was identified and closed with a sutured patch. Click the Related Article link for a complete review of mechanical complications of acute myocardial infarction and the related video links to watch imaging findings of left ventricular septal rupture and papillary muscle rupture.
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