Cardiac rupture or pericardial effusion?

After cardiogenic shock, myocardial rupture is the leading cause of in-hospital death from acute myocardial infarction (AMI). When possible, rapid diagnosis must lead to an emergency surgical repair to prevent sudden death. However, in some cases, despite new imaging techniques, the diagnosis may be difficult to obtain and the decision whether or not to operate, difficult. In the present report we describe the challenging case of a patient presenting a sub-acute cardiac rupture three days after anterior AMI.