Although left ventricular free wall rupture is more typical of older patients, we report a case of a middle-aged woman. The presence of familial hypercholesterolemia, in which cardiovascular diseases manifest earlier in life, and the prolonged time of myocardial ischemia without coronary reperfusion may justify this presentation. Moreover, female patients tend to be more affected than men, as they generally have more severe first myocardial infarctions [2, 3].
Echocardiography is the first line investigation exam for the diagnosis of free wall rupture, since it is easily accessible and can make a fast diagnosis. The main echocardiographic findings are pericardial effusion with or without intrapericardial echoes and signs of tamponade.
About one third of free wall ruptures are subacute and are characterized by a slow bleeding into the pericardial space . These cases are associated with lower mortality rate since patients can survive longer until surgical treatment. In this patient, this was probably the mechanism that led to the development of intrapericardial thrombus until the rupture was contained by pericardial adhesion and fibrosis. The definitive treatment of a myocardial rupture is emergent surgical repair, usually with a pericardial patch or epicardial sutures. Less often, aneurismectomy with ventricular wall reconstruction is performed . In this case, however, a type III myocardial rupture was found with a large pericardial symphysis naturally containing the rupture and for this reason only a fibrinogen and thrombin coated sealing matrix was placed for stabilization.