Unforeseen Threats: Mechanical Complications in the Aftermath of Acute Coronary Syndromes

Introduction: Acute coronary syndromes (ACS) are cardiovascular emergencies resulting from the rupture or erosion of atherosclerotic plaque in the coronary arteries. Despite therapeutic advances that have reduced mortality, serious mechanical complications, such as myocardial rupture, acute valvular insufficiency and ventricular septal defect, can still occur, increasing the risk of mortality. The present work aims to describe mechanical complications in ACS in our setting, examine their frequencies, pathophysiological mechanisms and therapeutic approaches through our series and literature review. Materials and methods: This retrospective study included 20 patients with mechanical complications of myocardial infarction, mainly diagnosed at the thoracic pain unit of the Mohammed VI University Hospital, Marrakech, and hospitalized in cardiology over a two-year period. Selected patients presented with myocardial rupture, acute mitral insufficiency, interventricular septal rupture, right ventricular free wall rupture or left ventricular aneurysm. Data on incidence, diagnosis and clinical outcome were analyzed. Results: During the study period, 20 patients, with a mean age of 69 and a female predominance, presented with post-infarction mechanical complications without a history of ischemic heart disease. The main complications included ventricular septal defects (50%), intramyocardial dissections (15%), acute mitral insufficiency (15%) and ventricular wall rupture. Echocardiography enabled rapid diagnosis. Half the patients were stable on admission, while three quarters progressed to cardiogenic shock, often fatal. Discussion and conclusion: Mechanical complications of ACS are rare but serious events that complicate patients' prognosis. Early detection by echocardiography or cardiac MRI, followed by surgical management, remains crucial to improving survival. Advances in early revascularization, notably coronary angioplasty, have helped to reduce the incidence of these complications, but optimal treatment of advanced cases relies on an experienced multidisciplinary team.