Ramkumar a 70 year old hypertensive 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 :

Ans. is 'd' i.e. external cardiac rupture Typical symptome of sudden decrease in B.P. and electromechanical disassociation seen in the first week of M.I., confirms the diagnosis of External cardiac rupture.Other features which also point towards the diagnosis of external cardiac rupture are -Old age of the patientH/O hypertensionNow let's see the details of myocardial rupture.It's a severe complication of M.I. occuring during the first week* after M.I. It causes heart failure (the myocardium continues to contract but forward flow is not maintained as the blood flows into the pericardium (due to free wall rupture) This condition is almost universally fatal.Its frequency increases with following features :First infarctionH/O hypertensionno H/O angina pectorisLarge Q wave infarctClinical presentationSudden loss of pulse, B.Puncons iousnessElectromechanical disassociation in E. C. G.About other options :Ventricular septal ruptureIt usually presents with features of left heart failure with a pansystolic murmurIt presents within the first few days.Mitral regurgitationIt also presents within the first few days after MI with features of left ventricular failure and a characteristic pan systolic murmur. It is very difficult to differentiate it clinically from ventricular septal rupture.Right Ventricular infarctionIt can be easily ruled out as right ventricular infarction does not occur in anterolateral myocardial infarction. It occurs in inferoposterior myocardial infarction.