Prediction of rupture in acute myocardial infarction

Abstract

Summary: In two patient series including 809 and 327 patients, respectively, with acute myocardial infwtion we have compared those who died in myocardial rupture (verified at autopsy, Group A) with those who died without rupture (autopsied, Group B), and those who survived hospitalization (Group C) with regard to previous history and clinical course in hospital. Rupture among autopsied patients was observed in 45% and 40% of the cases in the respective studies. Previous infarction was observed in each study as 0% and 0% in Group A compared with 25 % and 3 1 % in Group B, and 20 % and 34 % in Group C. Previous angina pectoris was observed in 26 % and 22 % in Group A compared with 50 % and 54 % in Group B and 52 9% and 54 % in Group C. Maximum serum enzyme activity in Group A did not differ from Group B, but was higher than in Group C (p<O.001). Group A patients tended to have a higher initial pain score and a higher requirement of analgesics compared with other groups, whereas initial heart rate or systolic blood pressure did not differ in these patients compared to others. We thus conclude that patients with myocardial rupture have a very low occurrence of previous myocardial infarction and angina pectoris, and that their pain course appears to be particularly severe in the acute phase.

An Echo-Dense Cap in the Pericardial Space After Acute Myocardial Infarction: A Case Report

“…It is triggered by the entry of blood into the pericardial cavity and is frequently transient because the following small hemopericardium acts as a tampon and prevents the further egress of blood. The onset of rupture might be heralded by chest pain, which may be very severe and resistant even to opiates, or by the classic clinical features of cardiac tamponade, shock with hypotension, quiet heart sounds, pulsus paradoxus, elevated venous pressure, bradycardia, or even electromechanical dissociation (6,7).…”

Repair of ventricle free wall rupture after acute myocardial infarction: a case report

“…It is provoked by the entry of blood in the pericardial cavity and is often transient because the resultant small hemopericardium acts as a tampon to prevent further egress of blood [7]. The onset of rupture may be heralded by chest pain [8], which may be resistant to opiates, or by the classic features of cardiac tamponade, namely, shock with hypotension, pulsus paradoxus, elevated venous pressure, quiet heart sounds, sinus bradycardia, or frank electromechanical dissociation [5]. …”

Caso 5/97 - Instituto do Coração do Hospital das Clínicas - FMUSP

“…Em 1 a 20% desses casos há rotura do SIV 10,12 , mais comumente na região apical 13 . A rotura do miocárdio ocorre mais em mulheres que em homens 14 , e é mais freqüente no 1º infarto 9,10,15,16 , geralmente em casos de obstrução coronária não muito extensa 17 , circulação colateral ausente ou pouco desenvolvida 1 e quando há formação de trombos murais 18,19 . O aneurisma ventricular pode ocorrer em 5 a 38% dos casos de IAM 12,15 , principalmente quando há extenso comprometimento da região ântero-septal e, geralmente, é diagnosticado na 1ª semana que se segue ao infarto 15,20 .…”