Postinfarction cardiac rupture: a challenge to try surgical reparation

68 patients deceased from AMI in CCU. They underwent postmortem examination and 12 patients displayed rupture of the free wall of the left ventricle at the sight of the infarction. Clinically, 8 deaths were preceded by an appearance or an increase of chest pain, which was only slightly affected by opiates; 9 patients displayed preterminal sinus rhythm, 2 atrioventricular block and 1 junctional rhythm. In all cases ST-segment was unchanged when the chest pain appeared and death occurred for the 8 patients who felt chest pain in a time interval between 35 and 660 minutes. One could observe a group with early rupture that deceased within 1 hour from the onset of this symptom and 4 patients with late rupture dying in a time-interval between 4 and 11 hours. Pathologically, cardiac hypertrophy and severe coronary alterations were found in all the hearts. Chest pain and unchanged ST-segment at the recorded electrocardiogram often in presence of sinus rhythm in patients showing clinical signs of cardiac hypertrophy should be considered an indication of impending rupture during the course of AMI. Consequently, we must plan a surgical reparation, the only treatment able to save the life of patients who have undergone postinfarction cardiac rupture.