Pathogenesis of Cardiac Rupture Due to Myocardial Infarction

Spontaneous Rupture of the Heart

“…On the other hand Lunseth and Ruwaldt (1956), in a study of the pathogenesis of cardiac rupture due to myocardial infarction, found no elevation of the blood pressure in their cases, in agreement with the earlier findings of Bean (1940). These contradictory opinions may perhaps be resolved along the following lines.…”

“…Involvement of the Thebesian veins was not conspicuous. I am in agreement with Lunseth and Ruwaldt (1956), who made a systematic search for Thebesian vein thrombosis and concluded that it played no significant role in the pathogenesis of cardiac rupture.…”

A Case of Myocardial Rupture on the Background of Coronary Artery Thrombosis

“…Van Torsel and Edwards, in reviewing 40 cases of cardiac rupture complicating acute myocardial infarction, presented evidence suggesting that the symptomatology in several patients was consistent with a gradual evolution of cardiac rupture 11 . Rupture of the midlateral wall was most common (32%) and usually occurred in the setting of an inferoposterolateral infarction related to an acute left circumflex artery occlusion in a retrospective and prospective study of 70 patients with rupture done by Oliva et al 12 Among 26 cases of myocardial infarction with cardiac rupture (found in 6791 necropsies), 12 cases (63.0 percent) were due to occlusion of the left descending branch of the left coronary artery; three cases (16%) were due to the occlusion of the circumflex branch of the left coronary artery; and four cases (21%) were due to the right coronary artery 13 .…”

Intramyocardial Dissecting Hematoma and Postinfarction Cardiac Rupture

“…In this series, transmural rupture was related to infiltrating hemorrhage in the necrosis surrounding tissues, with loss of tissular support and alterations of small vessels. Furthermore, it was suggested that the mechanism of rupture was somewhat similar to that which occurs in dissecting aneurysm of the aorta . The spatial disposition of ventricular myocardial fibers (helical ventricular myocardial band) has been related to its pumping function, and it is probable that it also has bearing on the trajectory of infiltrating hemorrhage between the myocardial bands.…”

“…At that time, Lunseth questioned the validity of the factors considered as predisposing, which included leukocytic and fatty infiltration, absence of fibrosis, and abnormalities of the full thickness of the myocardial wall, because these findings were also present in infarctions without CR. This author was one of the first to emphasize the frequent presence of IDH extending from the infarcted zone to the interstitial loose tissue …”