In a case study published in Clinical Cardiology, physicians at Thomas Jefferson University Hospital in Philadelphia reported on a seemingly healthy 55-year-old man who had a silent heart attack and subsequent unexplained chest pain.
Once he was admitted to the hospital, it was discovered that the man had a rarely diagnosed complication called subepicardial aneurysm, which, if not quickly treated, could be fatal.
"The chest pain was a rupture of the heart wall about to happen -- the most feared complication of a heart attack," says Michael Savage, M.D., director, Cardiac Catheterization Laboratory at Thomas Jefferson University Hospital, and one of the study's authors. "The rupture occurs from a tear in the muscle that has already been damaged by a heart attack. The heart muscle breaks, and the wall bursts, usually causing cataclysmic death soon after."
The Jefferson researchers recommend that when a patient experiences unexplained pain after a heart attack, doctors should consider the possibility of a subepicardial aneurysm.
Extremely Rare Cases
Diagnosis of a subepicardial aneurysm is extremely rare, according to Savage, who is also associate professor of medicine at Jefferson Medical College of Thomas Jefferson University.
Only 20 cases have ever been reported in the medical literature. It's highly likely that many more patients have died from this complication, but the cause of death was unrecognized.
According to lead researcher Aaron Giltner, M.D., a cardiology fellow at Thomas Jefferson University Hospital, the man, who worked in construction, came to the hospital emergency room with chest pain. A heart attack was initially considered, and the emergency physicians called in the interventional cardiologists for a consult.
A cardiac catheterization suggested a subepicardial aneurysm -- an impending cardiac rupture -- and the researchers arranged for a CT scan. This confirmed that the patient had a subepicardial aneurysm.
Once the problem was identified, surgeons promptly repaired the heart, thus saving his life.