An unexpected electrocardiogram sign of subacute left ventricular free wall rupture: Its early awareness may be lifesaving

BACKGROUND: Post-infarct left ventricular free wall rupture（LVFWR） is not always an immediately catastrophic complication.The rupture can be subacute, allowing time for diagnosis and intervention.Accordingly, early recognition of the entity may be lifesaving.METHODS: We present an electrocardiogram（ECG） change pattern in two cases, which was erroneously attributed to ischemia.Two women in their 80s were admitted to our institute after experiencing the sudden onset of chest pain.They were managed as anterior ST-segment elevation myocardial infarction without reperfusion treatment.Unfortunately, they experienced a recurrence of severe chest pain with cardiogenic shock during hospitalisation.The ECG recorded at that time showed a ST-segment re-elevation in infract-related leads.RESULTS: The two cases were regrettably received a misjudgement of reinfarction at first, and one of the patients even was administrated with tirofiban.Afterwards the diagnosis of subacute LVFWR was made through antemortem echocardiography.CONCLUSION: New ST-segment elevation（STE） in infarct-associated leads, coupled with recurrence of chest pain and new-onset hypotension, may constitute the premonitory signs of a subacute LVFWR.