Subacute cardiac rupture complicating myocardial infarction. A case report.

The authors have focused this study on the emergence of subacute ventricular free wall rupture in a seventy-six-year-old patient admitted to hospital for inferior acute myocardial infarction. After six days he showed clinical signs of bradycardia and hypotension evolving to electromechanical dissociation. Given an adequate pharmacologic therapy, the patient was submitted to echocardiography, which was believed to be consistent with myocardial rupture, showing a moderate to large pericardial effusion. Pericardiocentesis of 150 mL of bloody fluid resulted in a further improvement in his hemodynamics. The patient underwent cardiac surgery with repair of the myocardial rupture through a large diaphragmatic infarction by a Dacron polyester fiber graft and pacemaker placement. In conclusion the authors confirm the relevant role of clinical data such as persistent chest pain and hemodynamic instability and the value of echocardiography in identifying subacute myocardial free wall rupture after an episode of acute myocardial infarction.

Pleuropericarditis in a patient with ulcerative colitis in longstanding 5-aminosalicylic acid therapy.

We report a case of pleuropericarditis in a 23-yr-old woman with ulcerative colitis (UC) treated with 5-aminosalicylic acid (5-ASA). In our case we exclude a possible 5-ASA hypersensitivity in view of the longterm complication free treatment and the successful resolution of the case without withdrawal of 5-ASA. A 5-ASA induced lupus-like syndrome was also ruled out by immunoserological investigations. Infectious and endocrinologic causes of pleuropericarditis were also excluded. In conclusion pleuropericarditis must be considered a systemic complication of inflammatory bowel disease (IBD) if adverse reaction to 5-ASA and sulfasalazine as well as other possible pathogenetic factors have been ruled out.