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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