Left ventricular free wall rupture due to myocardial infarction in a patient presenting with clinical features of acute abdomen

Myocardial free wall rupture due to acute myocardial infarction (AMI) is a rare complication with an incidence of 2% to 4%. The patients’ complaints in AMI may not always be typical. In particular, the clinical presentation of inferior myocardial infarction may be confused with gastrointestinal symptoms. A 54-year-old male patient presented with acute abdominal pain, faintness, and sweating. On admission, there was no ST segment elevation related to AMI. Due to the presence of acute abdominal pain and shock symptoms, an urgent abdominal exploration was planned to identify abdominal pathology. Prior to exploration, echocardiography was performed to evaluate cardiac functions and to rule out any cardiac etiology associated with shock symptoms. It demonstrated myocardial free wall rupture and a hematoma compressing the right ventricle. He was referred to an emergency cardiac operation, during which he died due to uncontrolled bleeding through multiple ruptured areas in the myocardium.