Usefulness of sinus tachycardia and ST-segment elevation in V5 to identify impending left ventricular free wall rupture in inferior wall myocardial infarction

Cardiac rupture complicating myocardial infarction

“…Yoshino et al [74] demonstrated in seven patients who developed left ventricular free wall rupture following anteroseptal MI, that the only independent ECG finding associated with rupture was new or recurrent ST elevation in lead aVL (odds ratio 5.4). Our group recently demonstrated an association of sinus tachycardia and ST segment elevation in lead V5 with impending left ventricular free wall rupture in inferior wall MI [47] (see Fig. 1).…”

“…Distension of jugular veins also typically occurs with cardiac tamponade [47]. Oliva et al [65] reported that in more than 80% of all patients with, compared to only 3% in patients without rupture, at least two of the following symptoms occurred: recurrent chest pain due to pericardial irritation, vomiting, restlessness, and agitation.…”

“…Thrombolytic treatment in these patients may accelerate the clinical deterioration. The delay in hospital admission and associated continuation of ambulatory activities may be an additional risk factor for cardiac rupture [47].…”

“…It has been suggested that re-rupture might be prevented to some extent by using an intra-aortic balloon pump in the postoperative period [90]. Current operative mortality rates range from about 24% to 35%, with total in-hospital mortality rates of around 50 -60% [4,47,49,87].…”

Cardiac Rupture

“…We have recently shown that sinus tachycardia, ST-segment elevation in lead V 5 , or both may be independent predictors of rupture after inferior myocardial infarction. 2 On the basis of these criteria, patients with subacute rupture were identified with 75 percent sensitivity and 92 percent specificity. Precious time gained by the electrocardiographic diagnosis of cardiac rupture may be lifesaving in these patients.…”