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Left ventricular free-wall rupture that occurred during a cardiopulmonary exercise test
  1. Masaki Kodaira1,
  2. Takahito Itoh2,
  3. Kiyoshi Koizumi2,
  4. Yohei Numasawa1
  1. 1Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
  2. 2Department of Cardiovascular Surgery, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
  1. Correspondence to Dr Masaki Kodaira, mskodaira{at}


Although exercise testing has become a standard procedure before discharge for patients with acute coronary syndrome, a fatal accident during the test is extremely rare. A 60-year-old man was admitted for a non-ST-segment elevation myocardial infarction. A coronary angiogram showed stenosis at the distal lesion of the circumflex, and a balloon angioplasty was performed. His recovery was smooth, and a cardiopulmonary exercise test was performed 5 days after admission. At 2.5 metabolic equivalents, he suddenly went into cardiac arrest, and percutaneous cardiopulmonary support was initiated. Echocardiography revealed the presence of a large amount of pericardial effusion, and emergency cardiac surgery was performed to repair the free-wall rupture. This highlights the importance of careful monitoring of patients with percutaneous coronary intervention during cardiopulmonary exercise testing.

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  • Contributors MK was the attending physician and drafted the manuscript. TI and KK performed the surgery. TI, KK and YN revised the manuscript critically for important intellectual content.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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