A 91-year-old woman was admitted because of chest pain for 12 hours. Electrocardiography
showed ST-segment elevation on leads II, III, aVF. We therefore suspected an inferior
wall acute myocardial infarction. Transthoracic echocardiographic examination was
performed in the emergency room, which demonstrated that the inferior segment of the
left ventricular walls was akinetic with normal thickness in the 2-chamber view, but
the dissected myocardium and the aneurysmal pouch was observed in the area of inferior
segment. A small amount of pericardial effusion and diastolic right ventricular collapse
were detected. A subepicardial aneurysm with impending rupture was diagnosed and the
emergent surgical repair was prepared. Coronary angiography before operation revealed
total occlusion of the posterior descending artery of the right coronary artery; the
left anterior descending and circumflex arteries showed no abnormalities. The surgical
repair of subepicardial aneurysm was successfully performed and the patient was discharged
30 days after operation without any complications. Echocardiographic examination in
the emergency room was useful to detect the subepicardial aneurysm after myocardial
infarction and to decide the therapeutic strategy.
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