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At least 19 recordsLinked to original sources
PubMed1989

[Heart rupture as a complication of myocardial infarct].

The main causes of sudden death of patients suffering myocardial infarction are described. The authors established based on autopsy data the frequency, location, time of development, causes of possible pathogenetic mechanisms and morphology of ruptures of the heart in acute myocardial infarction.

Aged↗
PubMed1977

[Thormboembolisms and heart ruptures in myocardial infarct].

An analysis of the incidence of thromboembolism and heart ruptures with reference to different causative factors was conducted on the basis of 585 patients dying of myocardial infarction during the recent 30 years (autopsy data) and 1417 patients with myocardial infarction (298 mortality cases among them) hospitalized during the recent 10 years. A reduction of the incidence of thromboembolism and an increase of the incidence of heart ruptures in the recent years were revealed. Thromboembolism and heart ruptures play an important role among the causes of mortality in myocardial infarction. The development of thromboembolism in myocardial infarction is favoured by the macro-focal nature of the heart lesion, repeated necroses of the myocardium, localization of infarction in the posterior and posteriolateral zones, old age of the patients (over 60), presence of diabetes mellitus and acute cardiac aneurysm. Thromboembolism occurs with the same incidence rate within the initial 7 days, and later during the acute phase. Thrombi are most often found in the cardiac cavities, pulmonary, renal and splenic vessels, in the cerebral, mesenteric and other vessels. Heart ruptures are favoured by the macro-focal nature of the cardiac lesion, localization of the infarction in the anterior and anteriolateral zones, old age (over 60), presence of acute cardiac aneurysm. Most frequently the ruptures are observed in primary myocardial infarction within the initial 5--7 days of the disease. The use of anticoagulants in myocardial infarction decreases the incidence of thromboembolic complications and heart ruptures.

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PubMed1994

[Heart rupture in the acute period of myocardial infarction: prognostication and ways of prevention].

Clinical, instrumental, and biochemical examinations were carried out in 587 patients with transmural myocardial infarctions (381 patients with the first infarction and 206 ones with the repeated disease). Heart ruptures occurred in 5.7% of cases. Clinical forms and risk factors of heart rupture are described. Another group consisted of 815 patients with the first transmural infarction; in 44 patients at a high risk of heart ruptures preventive therapy with pantripin and contrykal was carried out. The incidence of heart ruptures was reduced twofold in this group as against the controls. Heart rupture risk factors in patients with myocardial infarction are described. The syndrome of excessive resorption in the pre-rupture period of myocardial infarction was singled out, manifesting by increased activities of lactate dehydrogenase, lysosomal enzymes, and elevated level of cardiac antigen. Lysosomal enzyme levels were measured in the myocardium in heart ruptures. The authors have defined the notion of 'mechanical incompetence' in myocardial infarction, consisting in inability of the involved myocardium to resist the intraventricular blood pressure. The program of heart rupture prevention in myocardial infarction is presented.

Aged↗
PubMedDate not supplied

Graded exercise in three cases of heart rupture after acute myocardial infarction.

Despite advances in the study of exercise for acute myocardial infarction (AMI) patients, few studies on exercise for post-AMI heart rupture patients have been reported. We assessed three cases of heart rupture (of the left ventricular free wall in two cases and of the ventricular septum in one case) in post-AMI patients who underwent three-graded exercise. Two of the three patients were operated on, whereas one patient was managed conservatively for heart rupture. Two of the three cases had also suffered cerebral infarction post-AMI. The exercise program was composed of three grades, slow level walking (grade 1), mild reconditioning and activities of daily living (ADL) exercises (grade 2), and optional endurance training using machines below 75% of predicted maximal heart rate (grade 3). Electrocardiograms and blood pressure were monitored during all exercises. All patients had muscle weakness, poor endurance capacity, as well as low cardiac function (28-47% of left ventricular ejection fraction). Two patients underwent grades 1 and 2 exercise programs, and the other performed grades 1, 2, and 3 exercise programs over a 3- to 10-wk period. We observed improvement in the double product, work capacity, and ADL without congestive heart failure, ischemic attack, or serious arrhythmias. However, the youngest patient, who underwent the grade 3 exercise program, died from a cardiac event 10 mo after onset of AMI. We conclude that post-AMI heart rupture patients should undergo delayed, gradual, low-level graded exercise (4-6 metabolic equivalents), with monitoring of blood pressure and electrocardiograms to improve work capacity, ADL, and the quality of life. However, daily activity and exercise intensity should be promptly supervised for those with severely deteriorated cardiac functions to prevent sudden cardiac event.

Activities of Daily Living↗
PubMed1983

[Heart rupture in acute myocardial infarct--analysis of 110 cases].

One hundred and ten cases of heart rupture (27%) were found among 408 postmortems of acute myocardial infarction from 1976 to 1982. After intensive care units were introduced the rate of rupture increased from 17% to 30% and reached 39% of the total. Ruptures were more frequent in women (32%) than in men (24%), their frequency increasing with the age; average age was 70 years in men and 72 years in women. Sudden death occurred in 16% of the patients; the interval between the first symptoms of infarction and death was 24 hours in 39% and 1 week or less in 90% of those affected. Most cases with extremely short history showed a fully developed infarction at autopsy. The rupture was, in fact, the first manifestation of latent ("silent") infarction. Less usual types of heart rupture (incomplete rupture, i. e. dissection of the free wall of the left ventricle and rupture of interventricular septum or papillary muscles of the left ventricle) are discussed in detail. Practical experience of the study is summarized in comments on heart autopsy.

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PubMed1993

[Heart rupture in the course of acute transmural myocardial infarction].

The purpose of the work was an assessment of the incidence of heart rupture as the complication of acute transmural myocardial infarction, and establishing of risk factors. In a retrospective study, among 150 patients hospitalized in the department in the years 1982-1992 and dying in the course of acute transmural myocardial infarction, in whom postmortem examination was done, 19 cases complicated with heart rupture were found. The analysis was carried out on the basis of autopsy results and clinical documentation. The studied group included 12 women (63.2%) and 7 men (36.8%). Most frequently encountered were ruptures of the free wall of the left ventricle (n = 12). The risk factors are: age over 60 years, female sex, arterial hypertension, left ventricular hypertrophy and the first myocardial infarction without earlier coronary complaints.

Adult↗
PubMed1999

[Heart rupture in acute myocardial infarct: the advantages of using M-2D color Doppler echocardiography in a coronary intensive therapy unit].

BACKGROUND: Free-wall rupture of the heart is the second most common cause of death in acute myocardial infarction (AMI), following pump failure. Acute rupture is more common and rapidly fatal, while subacute rupture, which accounts for about 30% of total cases of mortality in AMI, can be diagnosed early by clinical signs with the support of echocardiography in coronary intensive care units. METHODS: From March 1996 to December 1997, 293 patients diagnosed with acute myocardial infarction were admitted to the coronary intensive care unit of our hospital. Of these patients, 71 (23.8%) were treated with thrombolysis within 6 hours of onset of symptoms. All patients were observed daily with M-2D color Doppler echocardiography and in the event of renewed chest pain, electrocardiogram changes, abrupt hypotension, syncope or clinical signs of low output syndrome. RESULTS: We observed 11 cases (3.8%) of free-wall rupture of the heart in acute myocardial infarction with echocardiography, 6 females and 5 males, with a mean age of 74.2 +/- 7.8 years (min. 56-max 84), none of whom had prior AMI. Six of them received thrombolytic therapy, six were hypertensive (54.5%) and three were diabetics (27.2%). Surgical repair was performed in two patients with subacute rupture, but one died a few days later. The echocardiography data at bedside for diagnosis of cardiac rupture were confirmed in 5 patients with autopsy and intraoperatively in two of them. CONCLUSIONS: Routine use of echocardiography in coronary intensive care units allows prompt diagnosis of cardiac rupture in acute myocardial infarction, and in the event of subacute rupture it can accelerate surgical decision-making.

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PubMedDate not supplied

[Factors contributing to the onset of heart rupture in acute infarct].

The aim of this study was to find out the contributing factors for cardiac rupture in the course of acute myocardial infarction (AMI). Past medical histories and autopsy data of 80 patients were analyzed. The first group consisted of 30 patients who died due to heart rupture in the course of AMI and the control group of 50 patients who died from the other, more common complications of AMI. There was no difference between the groups according to age and sex of the patients. All patients who died from the rupture of the heart had a history of heavy chest pain, while it was lacking in 30% of the patients of the control group (p less than 0.01). All the first group patients showed electrocardiograms diagnostic for AMI, while it was lacking in 14% of the second group patients (p less than 0.05). Almost a half of the second group patients (47%) were in the class I of the Killip's classification, while only 20% of the control group did not developed left ventricular failure. Pathological study showed that the rupture of the heart most commonly occurred in the course of an anterior myocardial infarction. There was no difference according to the size of infarctions between observed groups, but the thickness of the left ventricular wall was significantly less (p less than 0.05) in the control group, and the heart weights were higher (p less than 0.05) in the control group. There was advanced atherosclerosis of the coronary arteries and about two thirds of the first group patients showed acute coronary thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1976

[External heart rupture in myocardial infarct (clinical picture, prospects for resuscitation)].

An analysis is presented on 53 cases of external ruptures of the heart in cases of transmural myocardial infarction. Most of the patients were above 60 years of age, with a hypertensive syndrome, with intensive, protracted, often recurring cardiac and retrosternal pains. The pains were interpreted as the manifestation of myocardial rupture. Blood tests revealed a high leucocytosis, an elevated level of lactate dehydrogenase and catecholamines excretion, mainly at the expense of noradrenaline, as well as an increased amount of serotonin, histamine, magnesium salts. A sudden onset of a catastrophic deterioration in the form of a cardiogenic shock was interpreted as a partial rupture with a progressively increasing penetrating rupture; clinical death with a preserved electrical activity of the heart--as its complete rupture. Cases of temporary efficieny resuscitation with a survival period in some cases of as long as 3 days are presented. The authors believe it possible to foresee a myocardial rupture, to diagnose it before the electrical activity of the heart ceases, to maintain the life of the patient so as to permit a cardiac surgical team to undertake an operative procedure.

11-Hydroxycorticosteroids↗
PubMed1985

[Heart rupture as a complication of myocardial infarct in the acute stage. Case contributions and clinical course of survivors].

Heart rupture was found in 25 (4.4%) of 560 patients with myocardial infarction admitted to the Coronary Care Unit of the Department of Cardiology, Padua Medical School. Ten (40%) of them had a breaking of the free wall, 10 the interventricular septum, 4 (16%) a papillary muscle and 1 (4%) the ventricular wall with formation of a pseudoaneurysm. Thirteen patients died suddenly, the other 12 (48%) had cardiac catheterisation and later surgery. Four patients with interventricular defect died immediately after surgery, the other patients were discharged. Mortality was 68%; 30% on the patients with VSD as well as those with papillary muscle rupture and pseudo aneurysm survived.

Female↗
PubMedDate not supplied

[Traumatic heart rupture or infarct?].

A 70-year-old motorist driving on the wrong side of the road caused a car-to-car head-on collision and died some minutes later. The autopsy revealed a lethal rupture of the right heart ventricle. The insurance company argued that driving on the wrong side was an act of gross negligence so that the damage was not covered by the full comprehensive insurance. Surprisingly, the microscopic examination of the myocardium performed by a clinical pathologist brought to light a severe myofibrillar degeneration (MFD) which was interpreted as diagnostic of acute myocardial infarction. It was supposed that this could have caused an incapacity of the driver to control his car, which in turn would commit the insurance to payment. A critical re-evaluation of the heart tissue material, however, revealed the pattern of trauma-induced hypercontraction banding of the myocardium along the cleft edges but no findings suggestive of myocardial infarction. Thus, the accident was not the result of a cardiac attack. But there was a severe preexisting pathology including cardiac hypertrophy, scarring of the myocardium, siderophages of the lungs, and an infarction of the pons, so that a cerebral dysfunction was the most plausible explanation for the accident. Thus, gross negligence had to be denied, and the insurance company was obliged to pay. This observation points to the existence of two different variants of MFD: Clinical pathologists are familiar with "tyical" MFD occurring in reperfusion after ischemia, in catecholamine toxicity, and around infarct necroses. But hypercontraction banding, regularly found along penetrating heart lesions and well known to forensic pathologists, is uncommon in clinical pathology.

Accidents, Traffic↗
PubMed2001

[Heart rupture by closed chest trauma].

Cardiac rupture is certainly unrecognised in the context of closed chest trauma. There have been few reports in the literature despite the fact that autopsy series show that it is the second cause of death after serious thoracic injury. The authors report three cases of traumatic rupture of the heart. The clinical presentation, apart from cardiogenic shock, differs according to whether there is an associated rupture of the pericardium. When the pericardium is intact, the diagnosis is suggested by the signs of tamponade: With earlier treatment of trauma by medical teams, this lesion should be diagnosed as soon as possible. Echocardiography has many indications in closed chest trauma. Early surgical intervention is the only treatment of these lesions.

Adult↗