Ramkumar a 70 year old hypeensive male was admitted in the intensive care unit with transmural anterolateral myocardial infraction. His condition was stable till fifth day of admission, when he developed a pericardial friction rub and pleuritic chest pain which persisted despite narcotic and steroid therapy. On the seventh morning, he suddenly developed marked hypotension. On examination there was marked distension of the jugular veins, accompanied with electromechanical dissociation. Most likely, the patient had developed :

Answer is D (External cardiac rupture) Typical symptoms of sudden decrease in B.P. and electromechanical disassociation seen. in the .first week of M.L, point to the diagn. External cc 'litre rupture. Risk factors Increasing age History of hypeension First infraction No history of angina Large Q wave infarct Presentation during first week following MI. Clinical presentation - Sudden loss of pulse. BP consciousness while ECG continues to show sinus rhythm i.e. electromechanical dissociation. The patient in question most diagnostic features leading us to a diagnosis of Myocardial free wall rupture.