[Heart rupture during maximal exercise test before hospital discharge after acute myocardial infarction].

A 64 years old patient performed a maximal exercise testing 13 days after inferoposterior myocardial infarction (no thrombolytic treatment had been performed). The patient presented at days 1-4 an intermittent Mobitz 1 and 2:1 heart block, with normal ventricular rate. No other complications were present. The ECG at entry and before stress test showed a complete right bundle block. The test was stopped at 30 sec of 75 watts. The systolic blood pressure increased from 130 to 155 mm Hg and heart rate from 84 to 145/min (93% of predicted heart rate). No arrhythmias and anginal pain were noted. The leads with pathologic Q wave showed elevation of the ST segment, whereas V1-V2 and aVL leads a depression of the ST segment. During recovery the patient developed electromechanical dissociation. The echocardiogram showed significant pericardial effusion. Cardiopulmonary resuscitation and pericardiocentesis were ineffective. Necropsy confirmed left ventricular inferior wall rupture and haemopericardium.