This echocariogram was obtained at day 6 after acute infero-posterior STEMI of a 60 years old man in a peripheral hospital with no primary PCI capability. He was hemodynamically stable, without chest pain and was lying flat in bed. Echocardiography was done before discharge to prepare him for angiography. What is the appropriate management in such case ?
Hi Mohammad,
You checked enzymes, did you? If you had still enzyme movement at discharge you should address the patient to a cath lab. Patent artery is always better.
Free wall rupture (pseudo-aneurysm), do the angio and discuss with surgeon for urgent surgery.
I agree with colleagues. It is urgent situation. Let us know whether it was possible to help this patient
Thank you all for your elegant contributions. An urgent coronary angiography was arranged few hours after echocardiography. Although it was an infero-posterior MI, but we found a totally occluded proximal LAD and 95 % occluded proximal RCA. Surgeons were consulted and surgery was arranged at the same night. The tear was repaired, the pseudo-aneurysm was resected, and CABG was done. Thanks God our patient is doing well, by time he was weaned from the ventilator.
