Clinical and Necropsy Findings in Rupture of the Myocardium

Rm, Ross; Ja, Young

doi:10.1177/003693306300800602

Cited by 20 publications

(2 citation statements)

References 10 publications

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“…28 The reason that higher levels of CRP are an independent predictor of cardiac rupture following MI is probably due again to a greater degree of activation of inflammatory cells, resulting in a more intense infiltration of leukocytes in the infarcted myocardial region which is known to be correlated with an increased risk of cardiac rupture. 29 The causes responsible for the higher levels of CRP in patients who undergo coronary events at follow-up are still elusive. In this study, seropositivity for Chlamydia pneumoniae and Helicobacter pylori were similar in cases and controls, suggesting that these microorganisms are unlikely to be major determinants of the higher levels of CRP in high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory predictors of mortality in the scandinavian simvastatin survival study

Crea

Monaco

Lanza

et al. 2002

Clinical Cardiology

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SummaryBackground and hypothesis: The predictive value of specific markers of infection and autoimmunity for coronary events, such as the effects of statins on inflammation, is still controversial.Methods: A case-control design was used to compare Creactive protein (CRP) levels, seropositivity for Chlamydia pneumoniae and Helicobacter pylori, and anti-oxidized lowdensity lipoprotein (oxLDL) antibody levels in prerandomization blood samples from 129 participants in the Scandinavian Simvastatin Survival Study who died (cases), and from 129 matched participants who were alive during 5-year follow-up (controls).Results: Patients with CRP levels in the highest quartile had an increased risk of death compared with those in the first through third quartile (odds ratio [OR] = 2.51, 95% confidence interval [CI] 1.3-4.8). Seropositivity for Chlamydia pneumoniae or Helicobacter pylori and anti-oxLDL antibody levels were similar in cases and controls (p = NS). At a 4-month control, simvastatin reduced CRP levels (p = 0.009) while placebo did not (p = NS). However, the risk of death associated with high baseline CRP levels was similar in patients randomized to placebo (OR = 2.36, 95% CI 1.06-5.26) or simvastatin (OR = 3.13, 95% CI 1.06-9.21).

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Section: Discussionmentioning

confidence: 99%

Inflammatory predictors of mortality in the scandinavian simvastatin survival study

Crea

Monaco

Lanza

et al. 2002

Clinical Cardiology

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“…Its incidence is 0.5-1.0% of all infarcts and this condition accounts for about 2% of all deaths due to myocardial infarction.'" 3 Although there have been a few reports of long-term survival. 4 this lesion usually is fatal, with up to 24% of the patients dying within 24 hours and 80-90% within 2 months.…”

Section: Balloon-induced Right Ventricular Outflow Obstructionmentioning

confidence: 99%

Balloon-induced right ventricular outflow obstruction: a new approach to control of acute interventricular shunting after myocardial infarction in canines and swine.

Babb¹,

Waldhausen²,

Zelis³

1977

Circulation Research

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Current management of ventricular septal defect (VSD) after myocardial infarction (MI) is aimed at improving left ventricular (LV) performance by afterload reduction as a means of hemodynamic stabilization or shunt control. The current investigation was undertaken to determine whether primary manipulation of right venticular (RV) performance by afterload enhancement was an effective means of reducing MI-VSD shunting. In five open-chest dogs an external LV-RV shunt was created with pulmonary-systemic flow ratios (Qp/Qs) averaging 2.26:1. Inflation of a balloon-tipped catheter in the main pulmonary artery (PA) reduced average QP/Qs to 1.28:1 and shunt flow from 783 to 343 ml/min. However, this increase in RV afterload caused further significant increases in RV systolic and end-diastolic pressure and suggested that deterioration of RV function might be limiting the usefulness of this technique. To investigate whether inotropic support for the RV would overcome this limitation, a similar shunt was created in 11 open-chest swine. We then investigated the effects of dopamine, infused at 24, 60, and 120 mug/min, on QP/QS and other hemodynamic variables both with and without PA balloon inflation. Optimal shunt control was obtained when effects of dopamine were added to those of PA balloon inflation. Shunt flow that had been 1,633 ml/min was reduced to 892 ml/min with the PA balloon and reduced further to 757 ml/min with dopamine, which also lowered RV and LV end-diastolic pressure and reduced total systemic vascular resistance. In four other swine with left anterior descending ligations, PA balloon inflation and dopamine infusion again favorably affected hemodynamics. Epicardial mapping in these swine showed an increase in S-T segment displacement, suggesting that the cumulative effect of these interventions allowed hemodynamic improvement at the expense of enhanced ischemic injury. These data indicate that acute RV outflow obstruction with a balloon catheter is an effective means of temporarily reducing acute ventricular shunting and that dopamine may be a useful pharmacological agent to use with RV afterload manipulation to stabilize a patient prior to transfer to a medical center for more definitive therapy.

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Current concepts of left ventricular pseudoaneurysm: Pathophysiology, therapy, and diagnostic imaging methods

March

Sawada

Tarver

et al. 1989

Clinical Cardiology

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Summary:Left ventricular pseudoaneurysm represents a cardiac rupture which is temporarily confined by pericardium and is amenable to curative surgical treatment. The case described illustrates several atypical features of its presentation and diagnosis, highlighting the importance of maintaining a sufficient clinical index of suspicion for this relatively uncommon, but potentially lethal entity. The use of various diagnostic imaging methods is described, including the first description of magnetic resonance imaging of ventricular pseudoaneurysm. The prospect of medical therapies directed toward the prevention of cardiac rupture, and thus pseudoaneurysm, is discussed in the context of its pathophysiology which involves alterations in the cardiac fibroskeletal support.

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Clinical and Necropsy Findings in Rupture of the Myocardium

Cited by 20 publications

References 10 publications

Inflammatory predictors of mortality in the scandinavian simvastatin survival study

Inflammatory predictors of mortality in the scandinavian simvastatin survival study

Balloon-induced right ventricular outflow obstruction: a new approach to control of acute interventricular shunting after myocardial infarction in canines and swine.

Current concepts of left ventricular pseudoaneurysm: Pathophysiology, therapy, and diagnostic imaging methods

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