A 66-Year-Old Man Comes to the Emergency Department Because of a 1-Day

A 66-year-old man comes to the emergency department because of a 1-day history of chest pain, palpitations, and dyspnea on exertion. He had a similar episode 3 days ago and was diagnosed with an acute myocardial infarction. He was admitted and a percutaneous transluminal coronary angioplasty was successfully performed that day. A fractional flow reserve test during the procedure showed complete resolution of the stenosis. Cardiac troponin concentrations were elevated. Other laboratory tests including serum glucose, lipids, and blood count were within normal limits. He was discharged the day after the procedure on a drug regimen of aspirin, simvastatin, and isosorbide dinitrate. At the time of discharge, he had no chest pain or dyspnea. Presently, his vitals are normal and ECG at rest shows new T-wave inversion in leads II, III, and aVF. Physical examination shows raised jugular venous pressure, no heart murmurs, and clear lungs.  He rapidly loses consciousness and becomes pulseless, and the subsequent resuscitation attempt is ineffective.  Which of the following most likely contributed to this patient's death?

A) Blood accumulation in the pericardial space
B) Complete rupture of the papillary muscle
C) Rapid reperfusion of the ischemic myocardium
D) Rupture of the interventricular septum
E) True aneurysm of the ventricular wall

Correct Answer:

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