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Classification of cardiac rupture complicated in myocardial infarction. Pathological study of 32 cases
Insights
Cardiac rupture (CR) is a severe complication of acute myocardial infarction (AMI), often occurring within the first week. Elevated myocardial wall tension is a key factor, with rupture types varying in presentation and timing.
Area of Science:
- Cardiology
- Pathology
Background:
- Cardiac rupture (CR) is a critical complication of acute myocardial infarction (AMI).
- Understanding the timing, types, and causes of CR is vital for patient outcomes.
Observation:
- Thirty of 91 acute myocardial infarction (AMI) cases (32.9%) presented with cardiac rupture (CR).
- Free wall rupture of the left ventricle was most common (21 cases), followed by ventricular septal perforation (6 cases).
- All ruptures occurred in transmural infarctions, with younger female patients in the ruptured group.
Findings:
- Elevated myocardial wall tension is strongly associated with CR.
- Rupture timing varied: early ruptures (within 24 hours) often involved the left anterior wall.
- Central ruptures increased after day 3, while peripheral ruptures occurred throughout the first week.
- Three CR types were identified: blowout, hemorrhagic dissecting (with unique ulcerations and fissures), and thinning-with-rupture.
Implications:
- This study highlights the significant incidence and varied presentations of CR post-AMI.
- Identifying risk factors and understanding CR mechanisms can inform preventative strategies and improve clinical management.
- Further research into the hemorrhagic dissecting type may reveal specific therapeutic targets.
Abstract:
Thirty of 32 cases with cardiac rupture (CR) complications in the myocardial infarction were found out of a total of 91 cases of acute myocardial infarction (AMI). The mean age of the ruptured group in females was significantly younger than that of the non-ruptured group. Twenty-one cases showed free wall rupture of the left ventricle, six perforation of ventricular septum and three double rupture. All cardiac ruptures occurred in cases of transmural infarction. The age of AMI was histologically estimated. Nine cases complicated within the first 24 hours of AMI showed rupture of the left anterior wall. CR in the periphery within the infarct occurred at any time during the first week after onset, and cases of the central rupture were increased in number after the 3rd day of AMI. Pathologic findings indicated that elevated wall tension was considered to be most closely related to the cause of CR. Thirty two cases of CR were classified into three types: (1) blowout type, (2) hemorrhagic dissecting type, and (3) thinning-with-rupture type. Hemorrhagic dissecting type was characterized by multiple endocardial ulcers and fissure canals extending from the ulcer with hemorrhage in the surrounding myocardium. Complex fissure was seen in two cases of this type.