[Myocardial rupture after acute myocardial infarct: 2 cases with an unusual clinical presentation]

Myocardial rupture is the second most common reason for in-hospital mortality in patients with acute myocardial infarction, accounting for 8-17% of deaths. The clinical presentation varies due to the possibility of rupture in three main locations: free left ventricular wall (85%), interventricular septum (10%), and papillary muscle (5%). Hypotension, long persisting or repeated chest pain, syncopes, new heart murmurs or weak action should draw attention to the possibility of myocardial rupture, apart from the classical sign of upper inflow congestion. In about 48% of cases immediate surgical intervention can save life. We present two unusual cases of myocardial rupture. Case 1 shows left ventricular free wall rupture with additional rupture of an accessory posterior papillary muscle but without changes in hemodynamic parameters; case 2 involves a rupture of the free left ventricular wall which the patient survived without surgical intervention.