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 tirofi ban.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.

First-in-man Implantation of the XINSORB Bioresorbable Sirolimus-eluting Scaffold in China

To the Editor：A 35-year-old man who smoked for 15 years suffered from chest pain 12 days ago before admission.He was diagnosed as myocardial infarction.Thrombolytic therapy was given consequently.The electrocardiogram showed sub-acute inferior wall myocardial infarction.Echocardiogram showed attenuated constriction of the inferior wall with an ejection fraction of 59％.On September 5,2013,he was treated with a XINSORB scaffold in right coronary artery （RCA）.

A benign course of sinus node artery occlusion after stenting at proximal right coronary artery

To the Editor:The sinus node artery(SNA)can be occluded during the percutaneous coronary intervention(PCI),which produces bradycardia.Previous studies showed a high incidence of SNA occlusion(SNO).Improvements in stent design and anti-thrombotic strategies have decreased branch occlusion.Here,we investigated the results of this procedure in our center.The incidence of SNO was 7.0%.The percentage of diameter stenosis of the SNA,SNA originating at a diseased right coronary artery(RCA),and larger RCA/SNA diameter ratio were independent predictors of SNO.Bradycardia occurred in SNO,but only one temporary pacemaker was implanted.SNO and the consequent bradycardia were not rare during PCI for severe RCA in current practice,yet they led to a benign clinical course with few temporary pacemakers.