[Cardiac rupture in acute myocardial infarction]

Free wall rupture of the heart is the most common cause of death following pump failure. The incidence of death is 10-16% of all deaths because of acute myocardial infarction (AMI). In respect of time between the onset of AMI to Cardiac Rupture (CR), early (80%) and late CR are distinguished. Other clinical classification distinguishes acute and subacute CR. CR is considered subacute if the time between the onset of typical symptoms of CR and irreversible shock is longer as 30 min. There are three problems to solve: 1) selection of patient particularly threatened with CR, 2) defining the prodroms of CR and early diagnosis, 3) advancing the methods of surgical treatment. CR occurs more often in women, hypertensive patients and patient > 60 years old sustaining the first infarction. Thrombolytic agents diminish overall mortality in AMI, but do not influence frequency of CR. There are three mechanisms of CR incidence: 1) blood effusion into the ischemic zone resulting in the loss of tissue strength, 2) influence of thrombolytic therapy on degradation and inhibition collagen synthesis, 3) absorption of collagen by lymphocyte infiltration in infarction zone. Cardiac insufficiency with cardiogenic shock and rapid increase of pericardial effusion in echo examination and electro-mechanical discordance are considered to be clinical signs of CR and tamponade. CRP is an independent marker of subacute CR. Surgical treatment is possible only in case of subacute CR. Pericardiocentesis and bloodletting could temporary diminish cardiac tamponade and allow transfer to the operating room.