Subacute ventricular free wall rupture complicating myocardial infarction

Raitt, Merritt H.; Kraft, Carol D.; Gardner, Carolyn J.; Pearlman, Alan S.; Otto, Catherine M.

doi:10.1016/0002-8703(93)90711-h

Cited by 84 publications

(50 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our results confirmed previous findings that patients with an MC are older and more likely to have a transmural infarction, less severe degrees of CAD (single-vessel disease or no CAD) and no previous MI [2, 3, 4, 6, 7, 11]. Furthermore, in agreement with earlier studies, we found that rupture occurs less frequently in patients treated with β-blockers immediately after the AMI [20].…”

Section: Discussionsupporting

confidence: 92%

“…Previous reports have focused mainly on clinical and pathological risk factors for MC [1, 2, 3, 4, 5, 6, 7, 8, 9, 10]. Known risk factors include advanced age, female gender, a first, anterior or transmural myocardial infarction (MI), and no history of previous smoking [3, 6, 7, 11]. Furthermore, ST-segment elevation in lead aVL on the admission ECG, abrupt hypotension or bradycardia have been described to be related to MC [12].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Mechanical Complications after Myocardial Infarction Reliably Predicted Using C-Reactive Protein Levels and Lymphocytopenia

Widmer¹,

Linka²,

Jost³

et al. 2003

Cardiology

View full text Add to dashboard Cite

We assessed the accuracy of C-reactive protein (CRP) levels and lymphocyte counts to predict a mechanical complication (MC) after myocardial infarction (MI). Within 10 years, we identified 36 patients with 39 echocardiographically confirmed MC within 30 days of MI: ventricular septal defect (17 cases), papillary muscle rupture (10 cases), and left ventricular free wall rupture (12 cases). They were compared to 41 controls with an uncomplicated hospital course after MI. Peak CRP levels and minimum relative lymphocyte counts obtained within 96 h of the acute MI (AMI) and before diagnosis of the complication were compared with clinical parameters. Prior to the MC, peak CRP levels were significantly higher (p < 0.001) and relative lymphocyte counts lower (p < 0.001) than in controls while creatine kinase levels did not differ (p = nonsignificant). Using multivariate logistic regression, the following score was identified to have excellent prognostic significance for MC: CRP (mg/l) – 10 × Lyc (%). The area under the receiver-operating characteristic curve was 0.90 ± 0.05 (p < 0.001). Combined use of CRP levels and relative lymphocyte counts may be helpful in accurately predicting an MC after AMI and should therefore be routinely assessed.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Mechanical Complications after Myocardial Infarction Reliably Predicted Using C-Reactive Protein Levels and Lymphocytopenia

Widmer¹,

Linka²,

Jost³

et al. 2003

Cardiology

View full text Add to dashboard Cite

show abstract

“…Left ventriculography is generally insensitive and impractical in a suspected case of frank myocardial rupture. 18 Left ventricular opacification with use of ultrasonographic contrast agents improves endocardial border definition in the face of technically suboptimal image quality. This imaging technique also substantially improves the evaluation of LV wall motion, wall thickness, and volume, and facilitates the recognition of intracardiac masses such as tumors and thrombi.…”

Section: Discussionmentioning

confidence: 99%

Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

Okabe¹,

Julien²,

Kaliyadan³

et al. 2015

Texas Heart Institute Journal

View full text Add to dashboard Cite

L eft ventricular free-wall rupture (LVFWR) is a life-threatening sequela of acute myocardial infarction. Contrast-enhanced echocardiography can be used urgently at the bedside to identify LVFWR. Early recognition is paramount, because emergency surgical correction is the only treatment. We describe the use of contrast-enhanced echocardiography in a patient who sustained pulseless electrical activity 5 days after a myocardial infarction (MI). Direct views of a tear in the myocardium enabled rapid confirmation of the diagnosis and expeditious surgical treatment. Case ReportIn January 2013, a 59-year-old woman with hypertension and hypercholesterolemia presented at another hospital with a 2-day history of chest pain. She was treated for non-ST-segment-elevation MI. Her initial serum troponin T level was 0.96 ng/mL (normal, <0.01 ng/mL). An electrocardiogram revealed ST-segment elevation in lead aVL, borderline but nondiagnostic ST-segment elevation in adjacent lead I, rsR′ in lead V 2 , and ST-segment depression in the anterolateral and inferior leads (Fig. 1). The patient was admitted to the intensive care unit and was given aspirin, low-molecularweight heparin, a glycoprotein IIb/IIIa inhibitor, and a nitroglycerin infusion. Her serum troponin T level peaked at 3.79 ng/mL.The patient was transferred to our hospital the next day for elective cardiac catheterization. An electrocardiogram revealed a recent posterolateral infarction (Fig. 2). Coronary angiograms showed an occluded left circumflex coronary artery; faint collateral vessels from a patent, dominant right coronary artery; a 70% stenosis of the first diagonal branch; and a 90% stenosis of the right posterior descending artery (RPDA). Left ventriculograms revealed severe hypokinesis of the inferolateral wall and overall mild left ventricular (LV) dysfunction. No intervention was performed, because the patient was no longer symptomatic and was well beyond 24 hours from symptom onset and presentation.On hospital day 3, the patient sustained a retroperitoneal hemorrhage and was transfused with 2 units of packed red blood cells. On hospital day 5, she became acutely unresponsive and pulseless while conversing with her family. Advanced cardiac life support was initiated immediately. She remained hemodynamically unstable and needed intravenous fluids and vasopressors. A bedside transthoracic echocardio-

show abstract

“…In some cases, the intrapericardial hematoma seals the site of myocardial perforation and may lead to the formation of a left ventricular pseudoaneurysm (11). A subacute variant of LVFWR, marked by slow, repetitive bleeding, occurs in approximately one-third of cases (6,12).…”

Section: Discussionmentioning

confidence: 99%

“…Prodromal manifestations include persistent chest pain (often erroneously attributed to ischemia), intractable vomiting, restlessness and ST segment elevation that persists for 72 h after the onset of chest pain (6,13). The classic signs of cardiac tamponade, including pulsus paradoxus and diastolic pressure equalization, are usually absent (12).…”

Section: Discussionmentioning

confidence: 99%

Myocardial infarction and left ventricular free wall rupture in a patient with a prior pericardiectomy

Gosal

Phillipp

Morris

2008

Canadian Journal of Cardiology

View full text Add to dashboard Cite

L eft ventricular free wall rupture (LVFWR) is a rare complication of acute myocardial infarction (AMI), occurring in approximately 2% of cases (1), and is often fatal because of the development of hemopericardium and tamponade. We describe a patient in whom free wall rupture occurred in the setting of previous pericardiectomy. Despite ongoing mediastinal hemorrhage, the diagnosis was established at cardiac catheterization and by computed tomographic scanning of the thorax, and surgical repair was performed. CASE PRESENTATIONA previously well 59-year-old man suddenly developed left shoulder pain, followed by intense central chest pain with bilateral arm radiation and diaphoresis while picking up garbage. When seen at a local nursing station, his heart rate was 140 beats/min and his blood pressure was 80/50 mmHg. An electrocardiogram showed sinus rhythm with complete right bundle branch block. There was ST segment elevation in the inferolateral leads and ST segment depression in leads V1 through V4.His cardiac risk factors included cigarette smoking, borderline hypertension and diet-controlled diabetes. He had undergone pericardiectomy for tuberculous pericarditis in 1970. He had been taking no medications.He was treated with acetylsalicylic acid. Thrombolytic therapy was not administered because of a concern about the possibility of aortic dissection. On arrival to the emergency department at the St Boniface General Hospital (Winnipeg, Manitoba), his chest discomfort persisted. His heart rate was 146 beats/min and his blood pressure was 86/54 mmHg. There were no signs of congestive heart failure and no heart murmurs. The arterial pulses were intact.The peak creatine phosphokinase and troponin T levels were 1202 U/L and 5.97 μg/L, respectively. A chest x-ray revealed right pleural effusion with an unusual dense area in the region of the right hilum.A contrast left ventriculogram revealed extravasation of contrast through the posterolateral wall of the left ventricle. Coronary angiography revealed 70% to 75% occlusion of the mid-distal circumflex artery. The mid-distal right coronary artery and the left anterior descending artery had insignificant stenosis of 40% to 50%.A transient episode of cardiac arrest with pulseless electrical activity required endotracheal intubation, inotropic support and insertion of an intra-aortic balloon pump. His hemoglobin level fell from 112 g/L to 67 g/L, and an urgent blood transfusion was initiated.Emergency transthoracic and transesophageal echocardiography were performed. The acoustic window was limited. An echo-free space with several immobile septi was identified anterior to the right ventricle. Cardiac rupture was suspected. A computed tomographic scan of the thorax confirmed extensive mediastinal hematoma in communication with the left ventricle.The cardiac surgery department was consulted and the patient was taken directly to the operating room. A defect of approximately 1 cm 2 in the posterobasal wall of the left ventricle was repaired. Coronary bypass grafting was not at...

show abstract

Subacute ventricular free wall rupture complicating myocardial infarction

Cited by 84 publications

References 62 publications

Mechanical Complications after Myocardial Infarction Reliably Predicted Using C-Reactive Protein Levels and Lymphocytopenia

Mechanical Complications after Myocardial Infarction Reliably Predicted Using C-Reactive Protein Levels and Lymphocytopenia

Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

Myocardial infarction and left ventricular free wall rupture in a patient with a prior pericardiectomy

Contact Info

Product

Resources

About