The Potential Impact of the Thrombolytic Era on Cardiac Rupture Complicating Acute Myocardial Infarction

Abstract

Cardiac rupture complicating acute myocardial infarction (AMI) remains a serious diagnostic and therapeutic challenge. The authors present 27 consecutive patients who died from cardiac rupture following AMI. These included 22 patients from 1975 through 1983 (prethrombolytic era) and 5 patients from 1984 through 1992 (postthrombolytic era) and all had postmortem examination. There were 16 men and 11 women with a mean age of seventy-two years. Myocardial infarction was anterior/anterolateral in 10 and inferior/inferoposterior in 17. Cardiac rupture followed AMI within one day in 14 (52%), two to five days in 8 (30%), and six to fourteen days in 5 (18%). Chest pain followed by sudden hypotension leading to electromechanical dissociation was the common terminal event. Cardiopulmonary resuscitation was unsuccessful in all patients. Postmortem findings showed three-vessel coronary disease in 21 (78%) and two-vessel disease in 6 (22%). Isolated free left ventricular wall rupture was found in 22 (81%), was anterior/anterolateral in 13 (48%), posterior in 9 (33%), and in conjunction with interventricular septum or papillary muscle in 5 (18%). Patients encountered in this series were mostly elderly hypertensives with multivessel coronary disease and postinfarction angina. Furthermore, cardiac rupture commonly occurred within the first five days of AMI and cardiopulmonary resuscitation was uniformly unsuccessful. During the thrombolytic era at their institution, this complication is now being seen much less often. These observations suggest that such interventions are expected to have a favorable impact on reducing the incidence of this catastrophic event.

Subacute left ventricle free wall rupture after acute myocardial infarction: awareness of the clinical signs and early use of echocardiography may be life-saving

“…Traditionally, factors considered to increase the risk of LVFWR would include advanced age (6 th decade or later), female gender, hypertension without left ventricular hypertrophy, delayed or no reperfusion, the anterior location of the AMI, no prior angina, a first myocardial infarction, poor collateral circulation to the infarct related area, use of NSAIDs or steroids during the acute phase, and high serum levels of C-reactive protein [3,4,10]. …”

Conservative Management of Subacute Contained Left Ventricular Rupture after Acute Myocardial Infarction

“…4,5 LVFWR is 8 to 10 times more frequent than rupture of the interventricular septum or papillary muscle. 4 According to Salem et al, 15 first 5 days of AMI is the most critical period during which most cases of cardiac rupture (82%) occur. Several studies have also shown a similar finding emphasizing the early occurrence of cardiac rupture.…”

An Unusual Case of a Giant Pseudoaneurysm Formation after Myocardial Infarction

“…About 30% of the ruptures occur within the first 24‐hour postinfarction and 90% occur within the first 14 days. Risk factors include advanced age, female sex, hypertension, first myocardial infarction, and poor coronary collateral circulation 3–5 . In cases of anterior transmural acute myocardial infarction, the rupture is usually located in the anteroapical part of interventricular septum, whilst in inferior infarctions the defect occurs in its basal part 6 .…”