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. 1985 Jul;54(1):11–16. doi: 10.1136/hrt.54.1.11

Rupture of the myocardium. Occurrence and risk factors.

M Dellborg, P Held, K Swedberg, A Vedin
PMCID: PMC481840  PMID: 4015910

Abstract

The occurrence of myocardial rupture was studied in a well defined unselected population of patients with acute myocardial infarction, and the group of patients who died of rupture of the heart were compared with two control groups. Of a total of 3960 patients, 1746 (44%) fulfilled the diagnostic criteria for acute myocardial infarction. Rupture was defined solely on the basis of the presence of a pathological passage through part of the myocardium, either the free wall of the left ventricle or the septum, found at necropsy or during operation. Two controls were selected for each patient and matched for age and sex, one (control group A) with acute myocardial infarction having died in hospital but not of rupture (non-rupture cardiac death) and one (control group B) with acute myocardial infarction having survived the hospital stay. Necropsy was performed in 75% of all fatal cases with acute myocardial infarction. The total hospital mortality was 19%, the highest mortality being among women over 70 years (29%). Ruptures (n = 56) were found in 17% of the hospital deaths, or 3.2% of all cases of acute myocardial infarction. Women aged less than 70 had the highest incidence of rupture, 42% of deaths being due to rupture. The mean age for patients with rupture and controls was 70.5 years. The median time after admission to death was approximately 50 hours for patients and control group A. Thirty per cent of the patients with rupture occurred within 24 hours of the initial symptoms occurring. Angina and previous acute myocardial infarction were more common among control group A. Patients with rupture and control group B were mostly relatively free of previous cardiovascular or other diseases (chronic angina pectoris ( > 2 months) and previous myocardial infarction). Sustained hypertension during admission to the coronary care unit was more common in patients than in control group A. Hypotension and shock were more common among control group A. Most (79%) of the patients who subsequently ruptured did not receive any corticosteroids at all during the hospital stay. Severe heart failure and antiarrhythmic treatment were more uncommon among patients than among control group A. Patients with rupture received analgesics approximately three times a day throughout their stay. Control group B received analgesics mostly during the first 24 hours. Thus female patients, patients with first infarcts, and patients with sustained chest pain should be investigated for the possibility of rupture. As many as one third (32%) of ruptures may be subacute, and therefore time is available for diagnosis and surgery.

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Selected References

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  1. Bashour T., Kabbani S. S., Ellertson D. G., Crew J., Hanna E. S. Surgical salvage of heart rupture: report of two cases and review of the literature. Ann Thorac Surg. 1983 Aug;36(2):209–213. doi: 10.1016/s0003-4975(10)60458-4. [DOI] [PubMed] [Google Scholar]
  2. Bates R. J., Beutler S., Resnekov L., Anagnostopoulos C. E. Cardiac rupture--challenge in diagnosis and management. Am J Cardiol. 1977 Sep;40(3):429–437. doi: 10.1016/0002-9149(77)90167-9. [DOI] [PubMed] [Google Scholar]
  3. Bulkley B. H., Roberts W. C. Steroid therapy during acute myocardial infarction. A cause of delayed healing and of ventricular aneurysm. Am J Med. 1974 Feb;56(2):244–250. doi: 10.1016/0002-9343(74)90603-2. [DOI] [PubMed] [Google Scholar]
  4. Christensen D. J., Ford M., Reading J., Castle C. H. Effect of hypertension on myocardial rupture after acute myocardial infarction. Chest. 1977 Nov;72(5):618–622. doi: 10.1378/chest.72.5.618. [DOI] [PubMed] [Google Scholar]
  5. Cobbs B. W., Jr, Hatcher C. R., Jr, Robinson P. H. Cardiac rupture. Three operations with two long-term survivals. JAMA. 1973 Jan 29;223(5):532–535. doi: 10.1001/jama.223.5.532. [DOI] [PubMed] [Google Scholar]
  6. Coma-Canella I., Lopez-Sendon J., Nuñez Gonzalez L., Ferrufino O. Subacute left ventricular free wall rupture following acute myocardial infarction: bedside hemodynamics, differential diagnosis, and treatment. Am Heart J. 1983 Aug;106(2):278–284. doi: 10.1016/0002-8703(83)90193-x. [DOI] [PubMed] [Google Scholar]
  7. Daggett W. M., Guyton R. A., Mundth E. D., Buckley M. J., McEnany M. T., Gold H. K., Leinbach R. C., Austen W. G. Surgery for post-myocardial infarct ventricular septal defect. Ann Surg. 1977 Sep;186(3):260–271. doi: 10.1097/00000658-197709000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. GRIFFITH G. C., HEDGE B., OBLATH R. W. Factors in myocardial rupture. An analysis of two hundred and four cases at Los Angeles County Hospital between 1924 and 1959. Am J Cardiol. 1961 Dec;8:792–798. doi: 10.1016/0002-9149(61)90241-7. [DOI] [PubMed] [Google Scholar]
  9. Goldstein S. Letter: Pacing the WPW patient. Circulation. 1976 Jan;53(1):204–205. doi: 10.1161/01.cir.53.1.204. [DOI] [PubMed] [Google Scholar]
  10. Hofvendahl S. Influence of treatment in a coronary care unit on prognosis in acute myocardial infarction. A controlled study in 271 cases. Acta Med Scand Suppl. 1971;519:9–78. [PubMed] [Google Scholar]
  11. Horowitz M. S., Schultz C. S., Stinson E. B., Harrison D. C., Popp R. L. Sensitivity and specificity of echocardiographic diagnosis of pericardial effusion. Circulation. 1974 Aug;50(2):239–247. doi: 10.1161/01.cir.50.2.239. [DOI] [PubMed] [Google Scholar]
  12. LONDON R. E., LONDON S. B. RUPTURE OF THE HEART. A CRITICAL ANALYSIS OF 47 CONSECUTIVE AUTOPSY CASES. Circulation. 1965 Feb;31:202–208. doi: 10.1161/01.cir.31.2.202. [DOI] [PubMed] [Google Scholar]
  13. Lewis A. J., Burchell H. B., Titus J. L. Clinical and pathologic features of postinfarction cardiac rupture. Am J Cardiol. 1969 Jan;23(1):43–53. doi: 10.1016/0002-9149(69)90240-9. [DOI] [PubMed] [Google Scholar]
  14. Naeim F., De la Maza L. M., Robbins S. L. Cardiac rupture during myocardial infarction. A review of 44 cases. Circulation. 1972 Jun;45(6):1231–1239. doi: 10.1161/01.cir.45.6.1231. [DOI] [PubMed] [Google Scholar]
  15. O'Rourke M. F. Subacute heart rupture following myocardial infarction. Clinical features of a correctable condition. Lancet. 1973 Jul 21;2(7821):124–126. doi: 10.1016/s0140-6736(73)93065-1. [DOI] [PubMed] [Google Scholar]
  16. Rasmussen S., Leth A., Kjøller E., Pedersen A. Cardiac rupture in acute myocardial infarction. A review of 72 consecutive cases. Acta Med Scand. 1979;205(1-2):11–16. doi: 10.1111/j.0954-6820.1979.tb05997.x. [DOI] [PubMed] [Google Scholar]
  17. SANDERS R. J., KERN W. H., BLOUNT S. G., Jr Perforation of the interventricular septum complicating myocardial infarction; a report of eight cases, one with cardiac catheterization. Am Heart J. 1956 May;51(5):736–748. doi: 10.1016/s0002-8703(56)80008-2. [DOI] [PubMed] [Google Scholar]
  18. SANDERS R. J., NEUBUERGER K. T., RAVIN A. Rupture of papillary muscles: occurrence of rupture of the posterior muscle in posterior myocardial infarction. Dis Chest. 1957 Mar;31(3):316–323. doi: 10.1378/chest.31.3.316. [DOI] [PubMed] [Google Scholar]
  19. Sievers J. Cardiac rupture in acute myocardial infarction. Geriatrics. 1966 Jul;21(7):125–130. [PubMed] [Google Scholar]
  20. Van Tassel R. A., Edwards J. E. Rupture of heart complicating myocardial infarction. Analysis of 40 cases including nine examples of left ventricular false aneurysm. Chest. 1972 Feb;61(2):104–116. doi: 10.1378/chest.61.2.104. [DOI] [PubMed] [Google Scholar]
  21. WESSLER S., ZOLL P. M., SCHLESINGER M. J. The pathogeneis of spontaneous cardiac rupture. Circulation. 1952 Sep;6(3):334–351. doi: 10.1161/01.cir.6.3.334. [DOI] [PubMed] [Google Scholar]
  22. ZEMAN F. D., RODSTEIN M. Cardiac rupture complicating myocardial infarction in the aged. Arch Intern Med. 1960 Mar;105:431–443. doi: 10.1001/archinte.1960.00270150085009. [DOI] [PubMed] [Google Scholar]

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