A 93 year-old woman was admitted to our hospital 8 hour after the onset of dyspnea.
Oxygen saturation was 95% under oxygen administration (5 L/min) on arrival. Congestive
heart failure was diagnosed on the basis of leg edema, jugular venous distention and
butterfly shadow on chest X-ray film. Electrocardiography showed ST segment elevation
in V1, V2 and V3. Echocardiography revealed severe hypokinesis of the left ventricular
apex and pericardial effusion. Emergent coronary angiography showed 100% obstruction
of left anterior descending artery. Oozing-type myocardial rupture due to acute myocardial
infarction was suspected, however, coronary intervention was not performed because
of the risk of progression to blow out-type rupture. Medical therapy was started in
coronary care unit under blood pressure control and diuretics administration. Dyspnea
and lung congestion gradually improved while pericardial effusion did not increase.
Myocardial rupture was covered by huge hematoma cap and this was continued for 5 weeks.
She transferred to nursing home. We report a case of super high-age patient with congestive
heart failure and myocardial rupture due to myocardial infarction who were successfully
treated by conservative medical therapy.
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