Review Paper: Myocardial Rupture After Acute Myocardial Infarction: A review
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Abstract:
Myocardial rupture complications after acute myocardial infarction are infrequent but lethal. They mainly involve rupture of the ventricular free wall, ventricular septum, papillary muscle, or combined. We compare features of different kinds of myocardial ruptures after acute myocardial infarction by reviewing the clinical insights. Tanzania Medical Journal Vol. 23 (1) 2008: pp. 30-33Keywords:
Heart Rupture
Papillary muscle
Cardiac Rupture
A clinicopathological study was made on a total of 6 cases of cardiac rupture following myocardial infarction, which was found among 50 cases of recent myocardial infarction with the incidence of 16%. Five out of 6 were women, age ranged from 68 to 88 with an average of 77 years old, and 5 cases showed a previous history of hypertension. In 3 cases both old and fresh myocardial infarctions were documented by electrocardiograms. Pathological examination showed the mixture of old scar or fibrosis and fresh myocardial infarction in all cases. Cardiac rupture occurred at the border of the old and fresh myocardial lesions presumed by increased strain at the junction area. Bizarre electrocardiogram at the time of cardiac rupture was shown in one of the cases, which was thought as extraordinarily rare.
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This article describes ventricular septal rupture in the acute phase of myocardial infarction after thrombolytic therapy. The peculiarity of this case is the lack of patient expressed pain and minimal manifestations of heart failure on the background specific to ventricular septal rupture ECG changes and echocardiographic data. To analyze the main factors giving the opportunity to assess the risk of this complication in patients with acute myocardial infarction. The clinical case demonstrates the success of the conservative management of patient with acute myocardial infarction complicated by early ventricular septal rupture.
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Summary Although myocardial rupture occurs in only 2% to 4% of cases of acute myocardial infarction (AMI), there is a high mortality rate due to acute cardiogenic shock. We present the anatomopathological findings of three cases of myocardial rupture in autopsied hearts in the last 30 years, with a diagnosis of cardiac rupture in acute myocardial infarction. In these 30 years the percentage of AMI with myocardial rupture was 0.2%. Risk factors for post-AMI myocardial rupture include older age, atherosclerosis, diabetes mellitus and systemic arterial hypertension.
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Out of 3673 patients with myocardial infarction treated between 1989 and 1998, 128 (54 males and 74 females) deceased due to left ventricle wall rupture (death rate: 18.5%). Thrombolytic therapy started to be used in 1992. It was administered in 36.0% patients with myocardial infarction in the years 1992-1998. Out of the patients deceased due to left ventricle wall rupture thrombolytic was carried out in 24.2%, predominantly in males (31.5%) as compared to females (18.8%). Left ventricle wall rupture during acute myocardial infarction occurred mainly in females (57.7%), in patients with first infarction (89.8%), in the case of anterior wall infarction (66.4%), hypertension (80.5%), in patients aged 61-80 and more (86.7%). Majority of the patients (83.6%) deceased because of this condition between 1 and 7 hospitalisation day, mainly during the first 48 hours (48.4%).
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Coronary care unit
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Forty-four cases of myocardial infarction with cardiac rupture, 88 cases of unruptured myocardial infarction, and 88 cases without myocardial infarction were studied retrospectively. The incidence of cardiac rupture in cases with acute myocardial infarction alone was 5.5% while in hearts having both healed and acute myocardial infarction the incidence was 2.3%. One instance of cardiac rupture was encountered in a heart having only a healed myocardial infarction with subsequent aneurysmal dilation of the healed infarct. Although females represented only 37% of the population having acute myocardial infarction in this institution, they accounted for 55% of the cases of cardiac rupture. On the average the hearts which ruptured following myocardial infarction were lighter and thinner than in the control group of patients having infarction without rupture. Among the clinical correlates possibly associated with postinfarction rupture the most significant finding in the present study is the presence of postinfarction hypertension. In the group of cases with cardiac rupture this was present in 40% while in the control group not having suffered cardiac rupture the comparable figure was 14%. A history of diabetes was found in 18% of the cases of myocardial infarction not having suffered cardiac rupture. A similar history was found in only 9% of the cases having a postinfarction cardiac rupture. This latter incidence is identical with the frequency of diabetes mellitus in the general autopsy population. There is a suggestion that early and severe atherosclerosis may cause earlier heart disease and when infarction occurs provide some protection against rupture. Of interest among the 44 cases of cardiac rupture, none of the patients had cirrhosis, in striking contrast to the 11% incidence of this condition in our general autopsy population.
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AIM: Myocardial rupture currently remains in most cases a fatal complication of myocardial infarction.
OBJECTIVE: To study the features of the structure of cardiovascular risk factors in men under 60 years old with complicated myocardial infarction to improve prevention.
MATERIALS AND METHODS: The study included men 1960 years old with type I myocardial infarction. The patients were divided into two groups age-comparable: I studied, with myocardial rupture seven patients; II control, without breaks 558 patients. A comparative analysis of the frequency of observation of the main and additional factors of cardiovascular risk in the selected groups was performed.
RESULTS OF THE STUDY: In the patients of the study group, frequent (four or more times a year) colds were observed more often than in the control group (42.9 and 14.8%, respectively; p = 0.04), the internal organs foci of infections (85.7 and 40.3%; p = 0.049), bypass surgery (57.1 and 10.2%; p 0.0001) and continuous cardiac pacing (28.6 and 0.5%; p 0.0001) in medical history. The presence of arterial hypertension (28.5 and 67.6%; p = 0.03) and foci of oral cavity infections (0 and 20.3%; p = 0.049) reduced the risk of myocardial rupture. In the study group, the levels of total cholesterol (4.3 0.3 and 5.8 1.2 mmol/l); p = 0.02), low-density lipoproteins (2.7 0.1 and 4.2 1.2 mmol/l); p = 0.04) and triglycerides (0.7 0.1 and 2.6 1.8 mmol/l); p = 0.008) were lower than in the control.
CONCLUSION: Combinations of these cardiovascular risk factors indicate an increased risk of myocardial rupture. It is advisable to use them for predictive modeling of this event and the formation of risk groups for the purpose of timely prevention, (bibliography: 18 refs.).
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