2022 Volume 29 Issue 2 Pages 137-140
Cardiac rupture is rare, but lethal complication of acute myocardial infarction. Early diagnosis and emergent surgical treatment are crucial to repair cardiac rupture. In this case, a winking coronary sign on coronary angiogram was observed just after percutaneous coronary intervention to distal-left anterior descending artery. Winking coronary sign was reported in some cases of ventricular septal rupture. We therefore anticipated cardiac rupture by monitoring parameters obtained from a Swan-Ganz catheter in the coronary care unit. Right atrial pressure, mixed venous oxygen saturation, and v wave in pulmonary arterial pressure are rapid and clear parameters of free wall rupture, ventricular septal rupture, and papillary muscle rupture, respectively. After 2-hr stay in the CCU, increasing right atrial pressure was displayed with concomitant complaints by the patient of discomfort. Blood pressure was 79/68 mmHg and cardiac tamponade due to free wall rupture was suggested. Large pericardial effusion was detected by echocardiogram and emergent surgery was performed. Winking coronary sign has been reported in ventricular septal rupture, but no previous reports have described this sign in free wall rupture. We could anticipate cardiac rupture by carefully monitoring parameters obtained from the Swan-Ganz catheter. Early diagnosis and emergent surgical treatment averted lethal outcomes.
