Subacute cardiac rupture: a surgical emergency

Three cases of subacute cardiac rupture following acute myocardial infarction are described. All three patients experienced sudden collapse during convalescence and following cardiopulmonary resuscitation were in cardiogenic shock, the shock being due to haemopericardium causing cardiac tamponade. Two of the patients who had electrocardiographic monitoring at the time of their collapse showed nodal bradycardia and were apnoeic and unconscious with no recordable blood pressure (electromechanical dissociation). The diagnosis was confirmed in all three patients by echocardiography which showed pericardial fluid. The patients were referred for urgent cardiac surgery (infarctectomy and Teflon patching) without further investigation. All three patients survived the emergency operation, but two died soon after surgery. The third patient is alive and well five months after the operation.