Post-Myocardial Infarction Left Ventricular Free Wall Rupture Diagnosed by POCUS

Background: ST segment elevation myocardial infarction (STEMI) is a common cause of death and disability in the United States. A rare, though highly morbid complication of STEMI is a rupture of the left ventricular free wall. Prompt recognition and action by emergency physicians is essential. This report describes a case of left ventricular free wall rupture in the setting of a STEMI, diagnosed by point of care ultrasound (POCUS) in the emergency department (ED). Case Presentation: A 72-year-old man presented with severe chest pain and STEMI on his electrocardiogram (ECG), days after an untreated episode of chest pain. Cardiac POCUS revealed a complex pericardial effusion with partially clotted blood, which raised concern for a rupture of the left ventricular free wall. Conclusion: Cardiac POCUS enabled providers to quickly recognize a complex pericardial effusion and cardiac tamponade in a patient presenting with a STEMI.