A patient with myocardial infarction and tamponade as a result of spontaneous rupture of an ectatic coronary artery

Abstract

Introduction: Spontaneous rupture of ectatic vessels is possible in different vascular beds and it can be life-threatening. Rapid diagnosis and initiation of appropriate treatment are essential. Case report: A 63-year-old man presented with chest pain in a state where he was sleepy. Vital signs at the time of admission included a systemic blood pressure of 90/70 mm Hg, heart rate of 100 beats per minute, tachypnea, and arterial blood oxygen saturation of 92%. Muffled heart sounds, normal lung and abdominal examination, coldness of all four end organs, and weak and filiform pulses were recorded. Electrocardiogram showed ST segment elevation in leads I and avL. The patient underwent echocardiography, which reported moderate pericardial effusion and possible hematoma inside the pericardial fluid. Emergency CT angiography showed only pericardial effusion and intrapericardial hematoma. Pericardectomy was performed and the patient's systemic pressure increased to 150/ 90 mm Hg. The patient was transferred to the angiography unit due to the persistence of chest pain, where severe ectasia of the coronary arteries and 100% occlusion of the first diagonal were suggested. Importantly, the general condition was good and full consciousness. After eight hours, the patient suddenly suffered from severe melena, and after half an hour, a cardiorespiratory arrest occurs. Conclusion: Rapid treatment is necessary in possible cases of rupture of ectatic vessels and may prevent death and irreversible complications. Ecstatic vessels may be present in different vascular beds and this question is raised whether it is necessary to check other systems after determining the presence of ectasia in one system.