Milking effect in coronary angiography due to left ventricular free wall rupture

Left ventricular free wall rupture is a potentially fatal complication of myocardial infarction. The prompt diagnosis of this condition is of high clinical importance. The patient, a 45-year-old man, with a history of hypertension and symptoms of chest pain and shock status, was admitted in the emergency department. Due to electrocardiographic changes consistent with myocardial infarction, he was transferred to cath lab for primary angioplasty (PCI). The initial echocardiographic assessment did not indicate any evidence of mechanical complication of myocardial infarction. Clinical condition of the patient did not improve after primary PCI. During the primary PCI, diagnosis of milking effect in the coronary arteries engendered suspicion of potential mechanical complications of myocardial infarction. Re-evaluation by echocardiography revealed left ventricular free wall rupture. Observing milking effect in angiography can be a result of mechanical complications of myocardial infarction.