Free-Wall Rupture of the Myocardium Following Infarction: A Changing Clinical Portrait in the Reperfusion Era: A Case Report

Weissman, Gaby; Kwon, Christopher C.; Shaw, Richard K.; Setaro, John F.

doi:10.1177/0003319706293152

Cited by 4 publications

(3 citation statements)

References 53 publications

(63 reference statements)

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“…More than 350 years after the first description of a LVFWR by William Harvey [2], it is still a diagnosis made more frequently at autopsy. Its estimated clinical incidence according to the SHOCK registry [3] is 2.7% of those patients presenting with an acute myocardial infarction (AMI) and cardiogenic shock; nevertheless, this may be an underestimation, since probably a vast majority of patients die immediately without confirmation of the cause of death.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant Role of CT in the Diagnosis of Post-Infarction Left Ventricular Free-Wall Rupture

et al. 2012

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Left ventricular free wall rupture is usually a catastrophic mechanical complication of myocardial infarction. Risk factors include advanced age, female gender and absence of prior infarction. The vast majority of patients succumb rapidly due to cardiac tamponade and electromechanical dissociation. Expedited and accurate diagnosis can improve the chances of survival. Echocardiography has been advocated as the gold standard for diagnosis, but other imaging modalities can provide valuable information in these patients. We present the case of a patient who presented with cardiogenic shock, in which the definitive diagnosis of a left ventricular free wall rupture was accomplished by CT scan with intravenous contrast.

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Section: Discussionmentioning

confidence: 99%

Adjuvant Role of CT in the Diagnosis of Post-Infarction Left Ventricular Free-Wall Rupture

et al. 2012

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“…LAD territory is the most common site of IRA (1,2,8). Poor collateral flow and the association with papillary insertion are the possible explanations (18,22). Pathological findings at the base of the papillary muscles and the area of septum/free wall junctions also indicate the rapid progression of initial endocardial tears into ruptures (23).…”

Section: Discussionmentioning

confidence: 99%

Acute Left Ventricular Rupture Following Posterior Wall Myocardial Infarction

et al. 2010

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Free wall rupture, the most fearful complication of myocardial infarction, mostly attacks anterior walls. Acute rupture is characterized by rapid development of mechanical arrest accompanied with bradyarrhythmia or electromechanical dissociation. The majority of patients succumb to death as the result of cardiac tamponade. Risk factors are advanced age, female gender, the first-time myocardial infarction, hypertension, and STsegment elevation. We report a rare case of posterior wall myocardial infarction complicated with left ventricular rupture initially presenting with junctional escape rhythm.

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“…До применения ТЛТ у больных с ОКС удельный вес НРС достигал 12,8-15,8% [10], современные источники свидетельствуют о снижении этого показателя до 7-8% [11]. При этом до 20% летальных исходов у больных после ТЛТ в настоящее время обусловлено именно развитием НPC [12].…”

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Death Causes and Their Prediction in Patients With the St Segment Elevation Acute Coronary Syndrome and Pre-Hospital Thrombolysis

Morozov¹,

Fedorov²,

Loskutova³

et al. 2013

Cardiovasc Ther Prev

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Aim. To assess effectiveness and safety of pre-hospital medical treatment in patients with acute coronary syndrome and ST segment elevation (ST-ACS) who are undergoing thrombolytic therapy (TLT); to identify TLT complications and the methods for their prediction.Material and methods. In total, the pre-hospital TLT effectiveness was assessed in 237 patients. The comparison group included 274 patients who did not undergo TLT, due to various reasons. The causes of death by Day 7–10 were analysed.Results. The leading cause of death was cardiogenic shock. In addition, in the main group, indirect myocardial rupture was a cause of death more often than in the comparison group (28% vs. 5,3%). Indirect myocardial rupture was associated with haemorrhagic complications of pre-hospital TLT. The proposed method for predicting TLT complications is based on the TIMI scale: 1–4 points suggest TLT safety; 4–5 points correspond to a higher risk of external myocardial rupture (11,6%), which implies the need to perform TLT under control of blood coagulation parameters; and ≥6 points denote the need to avoid pre-hospital TLT and use a mechanic reperfusion strategy.Conclusion. Among ST-ACS patients, mortality levels were 20,9%, which was 2,4 times higher than in the comparison group. In the main group, the morphological data obtained at autopsy demonstrated hemorrhagic myocardial transformation, which was associated with the high risk of indirect myocardial rupture (28,1%). In patients with pre-existing arterial hypertension and with the time from the ST-ACS onset of 2–3 hours, the risk of indirect myocardial rupture should be predicted, based on the TIMI scale. This will facilitate more effective assessment of the systemic TLT complication risk and selection of the optimal reperfusion strategy.

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Free-Wall Rupture of the Myocardium Following Infarction: A Changing Clinical Portrait in the Reperfusion Era: A Case Report

Cited by 4 publications

References 53 publications

Adjuvant Role of CT in the Diagnosis of Post-Infarction Left Ventricular Free-Wall Rupture

Adjuvant Role of CT in the Diagnosis of Post-Infarction Left Ventricular Free-Wall Rupture

Acute Left Ventricular Rupture Following Posterior Wall Myocardial Infarction

Death Causes and Their Prediction in Patients With the St Segment Elevation Acute Coronary Syndrome and Pre-Hospital Thrombolysis

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