Electrocardiogram in ventricular rupture after myocardial infarction: Case report

The case of a 54-year-old white woman is presented in which an electrocardiogram was recorded at or shortly after the time of rupture of the left ventricle on the fifth day after a diaphragmatic myocardial infarction. The chief features of the terminal electrocardiogram were transient ventricular fibrillation, marked intraventricular conduction defect, rapidly decreasing amplitude of the QRS waves, development of first-degree atrioventricular block, intermittent cessation of ventricular (QRS) complexes, and finally, disappearance of atrial activity (cessation of P waves). Autopsy findings gave an excellent correlation with clinical and electrocardiographic findings. As far as can be determined, there has been no previous report of electrocardiographic findings at the time of ventricular rupture. Most of the changes described on the terminal electrocardiogram have been described before in the dying heart and are not diagnostic of myocardial rupture. However, the decreasing amplitude of the QRS complexes may have indicated developing hemopericardium secondary to ventricular rupture.