Myocardial Rupture and Hemopericardium Associated with Anticoagulant Therapy

Waldron, Barzillia R.; Fennell, Robert H.; Castleman, Benjamin; Bland, Edward F.

doi:10.1056/nejm195411252512204

Cited by 58 publications

(8 citation statements)

References 8 publications

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“…In addition, although individual cases of massive hemopericardium associated with free wall ruptures6 7 or with anticoagulant therapy have been described,8' 9 the causes and the clinical significance of PE in most patients have not yet been confirmed. Therefore, it is not known whether the finding of PE favors the diagnosis of subclinical early postinfarction pericarditis, or whether it is predictive of the subsequent development of the postinfarction syndrome.…”

mentioning

confidence: 99%

Pericardial effusion in the course of myocardial infarction: incidence, natural history, and clinical relevance.

Galve¹,

Garcia-Del-Castillo²,

Evangelista³

et al. 1986

Circulation

101

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Incidence and significance of pericardial effusion in patients with acute myocardial infarction (AMI) have not been established. To evaluate these issues, we studied prospectively 138 consecutive patients with AMI. An echocardiogram was obtained in each 1, 3, and 10 days and 3 and 6 months after admission. Fifty four patients with unstable angina and 57 without heart disease were studied as controls. Echocardiographic diagnostic criteria of pericardial effusion were established from 33 additional patients undergoing surgery. Pericardial effusion was found in 28% of patients with AMI. Twenty-five percent of patients with AMI had pericardial effusion on the third day, vs 8% of patients with unstable angina (p < .02) and 5% of patients without heart disease (p < .01). At 1, 3, and 10 days and 3 and 6 months prevalence of pericardial effusion was 17%, 25%, 21%, 1 1 %, and 8%, respectively. There was no case of tamponade. Pericardial effusion was more common in anterior AMI (p < .02) and in patients with heart failure (p < .05) but it was not significantly associated with early pericarditis, peak creatine kinase-MB, the level of anticoagulation, or mortality. Thus, pericardial effusion is a common event in patients with AMI (incidence of 28%), but does not result in specific complications. cardiographic study was designed to determine prospectively the incidence, natural history, clinical relevance, and related factors of PE in the course of AMI. Material and methodsPatients. A total of 282 patients were distributed in four groups. Group I included 138 consecutive patients admitted to our coronary unit with AMI. AMI was diagnosed by the presence of at least two of the three following diagnostic criteria: prolonged suggestive chest pain, characteristic electrocardiographic (ECG) changes (new Q waves), and elevation of serum creatine kinase (CK)-MB level. Seven out of these 138 patients died within a few hours after admission before the first echocardiographic study could be recorded. The remaining 131 patients (1 15 men and 16 women, with ages ranging from 35 to 81 years, mean age 58 + 12 years) were prospectively studied with sequential echocardiographic recordings on days 1, 3, and 10 after admission, and 3 and 6 months after discharge. Ten patients were excluded because their echocardiographic recordings were considered of inadequate quality. Accordingly, group I consisted of 121 analyzable patients.Group II was a control group including 54 patients admitted for unstable angina. Ages and sex distribution were comparable to those of patients in group I. Diagnostic criteria of unstable angina were effort angina with a clearly progressive pattern or angina at rest with repeated attacks or with attacks lasting longer than 15 min; and absence of new Q waves on the echocardio-CIRCULATION 294 by guest on

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mentioning

confidence: 99%

Pericardial effusion in the course of myocardial infarction: incidence, natural history, and clinical relevance.

Galve¹,

Garcia-Del-Castillo²,

Evangelista³

et al. 1986

Circulation

101

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“…In addition to varying the site of deposi¬ tion and type of administration in order to alter the rate of absorption of heparin, a diminished rate of absorption has been ob¬ served when the compound is administered intramuscularly in special media, such as gelatin and dextrose, with or without vasoconstricting drugs.3· 12· 1ß· 2ß'28-3ß· 37,42,43,59,65 Since the preliminary report in 1944 on the use of prolonged acting heparin by Loewe and Rosenblatt,3' the media have been great¬ ly improved. Because of the depot effect of the slowly absorbed menstruum containing the heparin, a therapeutic level may be maintained by a single dose over a period of between 12 and 48 hours.…”

Section: Methodsmentioning

confidence: 99%

“…The use of heparin and the prothrombin\x=req-\ depressing drugs has been established in the treatment of myocardial infarction, venous thrombosis, and peripheral arterial thromboembolism. [10][11][12][13]22,29,34,55,60,65,[70][71][72] Murray44,45,47 reported satisfactory results with the administration of heparin in association with blood vessel surgery there has been a general acceptance of the value of this agent for irrigating the open lumen of a blood vessel during the performance of an anastomosis, for the irrigation of catheters left in blood vessels, for instillation into blood vessels adjacent to occluding instruments, and for the irrigation of arterial or venous grafts.6-16·24'41·70 Strangely enough, the proper role of sys¬ temic anticoagulation in the period following the implantation of a vessel replacement for arterial occlusive disease has never been clearly defined ; nor has the optimum time of initiating such a program or the most satis¬ factory method of administering heparin been properly established. The studies be¬ ing reported had as their purpose the clari¬ fication of some of the factors involved in the answers to these questions.…”

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confidence: 99%

The Effect of Heparinization upon Vascular Healing

F¹

1957

Arch Surg

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“…This pericarditis may result in an adhesion of the pericardium and epicardium in the area of the infarction. According to the literature [3], anticoagulation does not increase the risk of a hemorrhagic pericardium.…”

Section: Introductionmentioning

confidence: 99%

Pericardial Pseudodiverticulum or Pseudoaneurysm due to Rupture of a Cardiac Aneurysm into the Pericardial Sac 48 Years after the First Description

Riederer

2004

Cardiology

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A typical sequential course becomes apparent from the clinical features, the electrocardiography, echocardiography, radiological changes as well as angiographic results. This ultimately leads to an unusual complication of transmural myocardial infarction, i.e. the development of a pericardial pseudodiverticulum (less aptly described as pseudoaneurysm or false aneurysm). A timely cardiosurgical intervention may avert the otherwise fatal outcome.

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Myocardial Rupture and Hemopericardium Associated with Anticoagulant Therapy

Cited by 58 publications

References 8 publications

Pericardial effusion in the course of myocardial infarction: incidence, natural history, and clinical relevance.

Pericardial effusion in the course of myocardial infarction: incidence, natural history, and clinical relevance.

The Effect of Heparinization upon Vascular Healing

Pericardial Pseudodiverticulum or Pseudoaneurysm due to Rupture of a Cardiac Aneurysm into the Pericardial Sac 48 Years after the First Description

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