Cardiac rupture—challenge in diagnosis and management

Bates, Robert J.; Beutler, Steven; Resnekov, Leon; Anagnostopoulos, Constantine E.

doi:10.1016/0002-9149(77)90167-9

Cited by 210 publications

(55 citation statements)

References 65 publications

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“…Nevertheless, and as indicated, our low numbers are concordant with those reported by others. 13,16,18 -20 In fact, FWR most often presents as sudden death resulting from EMD 3,6,19 ; is often unresponsive to resuscitative maneuvers, including pericardiocentesis 4 ; and in our series frequently occurred in the evening or at night. Moreover, CR patients were elderly-40% were Ͼ75 years of age-and often presented extensive STEMI 13 conditions that hamper recovery from a cardiac arrest.…”

Section: Figueras Et Al Cardiac Rupture and Death 2787mentioning

confidence: 73%

“…C ardiac rupture (CR) constitutes the second-mostcommon cause of in-hospital death in ST-elevation myocardial infarction (STEMI) patients [1][2][3][4][5] and occurs mostly among those Ͼ55 to 60 years of age 1,6,7 with a first infarction [7][8][9][10] and without overt heart failure. [7][8][9][10] It is uncertain, however, whether the incidence of CR and its hospital mortality rate have been altered by evolving therapeutic strategies and whether the clinical profile of these patients has changed over the years.…”

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confidence: 99%

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Changes in Hospital Mortality Rates in 425 Patients With Acute ST-Elevation Myocardial Infarction and Cardiac Rupture Over a 30-Year Period

et al. 2008

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Background-Possible changes in the incidence and outcome of cardiac rupture in patients with ST-elevation myocardial infarction over a long period of time have not been investigated. Methods and Results-The incidence of cardiac rupture in ST-elevation myocardial infarction patients and its mortality rate were investigated during a 30-year period divided into 5 intervals (1977 to 1982, 1983 to 1988, 1989 to 1994, 1995 to 2000, and 2001 to 2006

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Section: Figueras Et Al Cardiac Rupture and Death 2787mentioning

confidence: 73%

mentioning

confidence: 99%

Changes in Hospital Mortality Rates in 425 Patients With Acute ST-Elevation Myocardial Infarction and Cardiac Rupture Over a 30-Year Period

et al. 2008

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“…2 The effective use of antiarrhythmic drugs has reduced the mortality of myocardial infarction. Attempts are underway to limit myocardial infarct size, and to support patients with cardiogenic shock with the hope of improving mortality.…”

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confidence: 99%

Expansion of transmural myocardial infarction: a pathophysiologic factor in cardiac rupture.

Schuster¹,

Bulkley²

1979

Circulation

214

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SUMMARY The 10-20% incidence of cardiac rupture in acute fatal myocardial infarction has not changed in the past century, and little is known about its pathophysiology. To determine whether expansion acute dilatation and thinning of the area of infarction not explained by resorption of necrotic tissue -may be a variable predictive for rupture, we studied 110 consecutive autopsied patients who died of acute myocardial infarction. The presence and severity of expansion was determined qualitatively on a scale of 0-4+ from review of the postmortem radiographs, and quantitatively by a ratio of wall thickness adjacent to the rupture site to thickness of noninfarcted wall. By radiographs, 54 (49%) had expansion, of whom 23 (43%) had rupture in the zone of expansion; of the 56 cases without expansion only one (2%) had ruptured (p < 0.005). The severity of expansion related to rupture: 50% with 3-4+ expansion ruptured, compared with only 23% with 1-2 + expansion. Wall thickness ratios for patients without expansion were 0.93 ± 0.10; for those with expansion but no rupture, 0.62 ± 0.16; and 0.49 ± 0.13 for those with expansion and rupture (p < 0.01). Wall thinning in these three groups was noted at average postinfarction intervals of 8, 7 and 5.5 days, respectively too early to be caused by resorption.Thus, expansion of acute myocardial infarction is a previously unappreciated variable that appears to be predictive of rupture, suggesting that regional dilatation and thinning of newly infarcted myocardium may be of pathogenetic importance in the development of rupture. Since expansion can be identified with twodimensional echocardiography, and occurs over days, these findings suggest that patients at high risk for rupture might be recognized early and interventions to prevent further expansion and rupture evaluated.CARDIAC RUPTURE in acute fatal myocardial infarction has a 10-20% incidence that has not changed in the past century." 2 The effective use of antiarrhythmic drugs has reduced the mortality of myocardial infarction. Attempts are underway to limit myocardial infarct size, and to support patients with cardiogenic shock with the hope of improving mortality. Yet the percentage of patients with acute myocardial infarction who die from cardiac rupture still remains high. Cardiac rupture is estimated to account for 25,000 fatalities a year in the United States,2 and, after cardiogenic shock and arrhythmias, is the most common cause of death in patients with myocardial infarction. This mortality is especially troublesome in that most reports2-10 agree that patients who die from cardiac rupture tend to have only one relatively small transmural infarction. One would expect that if these patients had not ruptured, their prognosis would have been favorable.Little is known of the pathophysiology of rupture, a factor that limits any attempts to alter its occurrence. Postulated mechanisms for cardiac rupture include a decrease in tensile strength, a high intracavitary pressure, ruptured intramural venous channels and a paradoxi...

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“…On the other hand, hypertension following acute MI has been noted to predispose to myocardial rupture by others (Bates et al, 1977;Naeim er al., 1972). We observed that hypertension exceeding 150/90 mmHg following acute MI was present in 54% of the ruptured group, which is significantly higher than in the nonruptured group (15%).…”

Section: Risk Factors For Myocardial Rupturementioning

confidence: 99%

Potential prevention of myocardial rupture resulting from acute myocardial infarction

Nakano

Konishi

Takezawa

1985

Clinical Cardiology

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Summary:The clinical characteristics of 30 cases of myocardial rupture resulting from acute myocardial infarction were analyzed. Predisposing factors of myocardial rupture appeared to be the following (1) age 60 years or older, (2) female, (3) no previous history of angina or myocardial infarction, (4) hypertenstion on admission, (5) persistent or recurrent chest pain, (6) physical activity and/or emotional unrest, (7) less than 10 days since the onset of myocardial infarction. From 1979 to 1982, we tried to eliminate these risk factors in the acute stage of myocardial infarction, of which hypertension appeared to be the most important and main correlating factor. The incidence of myocardial rupture before elimination of risk factors was 3 1.2 % (26 of 84 patients) which was reduced to 8.8% after elimination. In the years 1981 and 1982, only two cases of myocardial rupture were found in each year, 4.3% and 5.6% of MI patients, respectively.

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Cardiac rupture—challenge in diagnosis and management

Cited by 210 publications

References 65 publications

Changes in Hospital Mortality Rates in 425 Patients With Acute ST-Elevation Myocardial Infarction and Cardiac Rupture Over a 30-Year Period

Changes in Hospital Mortality Rates in 425 Patients With Acute ST-Elevation Myocardial Infarction and Cardiac Rupture Over a 30-Year Period

Expansion of transmural myocardial infarction: a pathophysiologic factor in cardiac rupture.

Potential prevention of myocardial rupture resulting from acute myocardial infarction

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