Interesting case of Intramyocardial Dissecting Hematoma

Introduction - Intramyocardial dissecting hematoma (IDH) is a rare form of cardiac rupture that can occur as a complication following acute myocardial infarction or during the remodeling process, or chest trauma, or surgery or after reperfusion procedures or even spontaneously. We describe a case of Intramyocardial dissecting hematoma (IDH) after acute anterior wall myocardial infarction.Case presentation - A 60 yrs old female patient with known coronary artery disease (anterior wall myocardial infarction 1 months back and not lysed) was admitted with history of anginal chest pain and dyspnoea NYHA class II in our ccu. Her 12 lead ECG showed Qs complex in V1 to V6 and T inversion in V1 to V6 with LAFB and X ray was appears normal.On Echocardiography, a myocardial flap was seen in the left ventricular apex and in between the flap and part of Left ventricular wall echo free space is present which contain the thrombus. During color Doppler Blood entered into the Echo free space by small rent in the flap.On MRI , clearly delineate the tear in the myocardium with hematoma in the myocardium.Because of hemodynamic stability and Economical and logistics reasons conservative approach was assumed.Conclusion - Intramyocardial hematoma is rare manifestation of Acute myocardial infarction. Previously it was believed that the prognosis of intramyocardial dissection was invariably fatal in the short to midterm in those patients who did not undergo surgery but in our case progressive thrombus formation of hematoma will seal the dissection inspite of dual antiplatelet and anticoagulation and patient improved with conservative approach.