ABC | Volume 114, Nº2, February 2020

Image Abdominal Pain: an Uncommon Presentation of Myocardial Rupture Daniel Seabra, 1 Ana Neto, 1 Inês Oliveira, 1 Rui Pontes dos Santos, 1 João Azevedo, 1 Paula Pinto 1 Centro Hospitalar do Tâmega e Sousa, Departamento de Cardiologia, 1 Penafiel – Portugal Mailing Address: Daniel Seabra • Centro Hospitalar do Tâmega e Sousa, Departamento de Cardiologia. Avenida do Hospital Padre Américo, nº 210, Guilhufe. Postal Code: 4560-136, Penafiel – Portugal E-mail: danielseabra.carvalho@gmail.com Keywords Abdominal Pain; Myocardial Infarction/complications; Echocardiography, Doppler/methods; Thrombosis/ surgery; Hypertension; Dyslipidemias; Tomography, X-Ray Computed/methods. DOI: https://doi.org/10.36660/abc.20190495 An 84-years-oldwomanwith hypertension and dyslipidemia was admitted in the emergency room with acute abdominal pain; patient complained of chest pain three weeks before hospital admission. On physical examination, she was hypotensive, tachycardic (with arrhythmic pulse), tachypneic and with diffuse abdominal pain. Electrocardiogram showed atrial fibrillation with rapid ventricular response, complete left bundle branch block and inferior Q waves. Abdominal computed tomography (CT) revealed a thrombus in the superior mesenteric artery (Figure 1, white asterisk). The patient showed a clinical course with congestive heart failure and low cardiac output. Transthoracic echocardiogram (Videos 1-2) showed mild left ventricular dilatation with a mild dysfunction and a pseudoaneurysm of the basal half of the posterior and inferior walls with left-to-right shunt, confirmed by color Doppler imaging (Figure 2 A-D). Cardiac CT (Video 3) revealed contained myocardial rupture, located at the basal segments of the inferior and posterior septal walls, extending to the free wall of the right ventricle, forming a pseudo-cavity, which communicates with the true cavity of the right ventricle (Figure 3). Despite vasopressor and inotropic support and proposal for cardiac surgery, the patient had an unfavorable course. Myocardial rupture demands a prompt diagnosis. 1 Occurrence of late myocardial infarction should raise suspicion and clinical signs may be atypical. 2 This case illustrates an interesting entity – pseudoaneurysm, with left-to-right shunt and containedmyocardial rupture, which extended to the right ventricle, leading to a dismal prognosis. Contribuição dos autores Conception and design of the research: Seabra D; Acquisition of data, analysis and interpretation of the data and writing of the manuscript: Seabra D, Neto A, Oliveira I; Critical revision of the manuscript for intellectual content: Seabra D, Santos RP, Azevedo J, Pinto P. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 319