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[Heart rupture in acute myocardial infarct]
Insights
Cardiac rupture (CR) occurred in 12% of acute myocardial infarction (AMI) deaths. Previous myocardial infarction may reduce CR risk, while cardiokinetic therapy might increase it, especially with high doses.
Area of Science:
- Cardiology
- Pathology
Context:
- Cardiac rupture (CR) is a severe complication of acute myocardial infarction (AMI).
- Understanding CR's incidence and risk factors is crucial for patient outcomes.
Purpose:
- To investigate the incidence and predisposing factors of cardiac rupture in patients deceased from acute myocardial infarction.
- To analyze the temporal relationship between AMI onset and CR, and identify potential premonitory signs.
Summary:
- Cardiac rupture (CR) was observed in 12% of 200 necropsies for acute myocardial infarction (AMI).
- Factors like age, sex, AMI site, hypertension, diabetes, and anticoagulant/corticosteroid use were insignificant.
- Previous myocardial infarction appeared to reduce CR incidence, which predominantly occurred within the first 3-4 days post-AMI and never after 21 days.
- Persistent precordial pain without pericardial friction was a key premonitory sign.
- The increased frequency of CR may be linked to the prevalent use of high-dose cardiokinetic therapy during AMI.
Impact:
- Findings suggest cautious use of cardiokinetic therapy in high-risk AMI patients, favoring smaller doses after other treatments.
- Recommendations include considering emergency surgery or preventive infarctectomy for high-risk individuals.
- Highlights the importance of monitoring for precordial pain as a warning sign of impending CR.
Abstract:
24 cases of cardiac rupture (CR) (12%) were found in 200 necropsies of patients who died from acute myocardial infarction (AMI). Examination of the various factors that may affect the onset of this complication showed that age, sex, the site of AMI, the presence of coronary thrombosis, the association of persistent arterial hypertension, diabetes mellitus or previous angina syndrome and anticoagulant and corticosteroid treatment are insignificant. On the other hand, previous myocardial infarction would appear to reduce incidence considerably. CR was much more frequent in the first 3-4 days after onset of AMI and never occurred more than 21 days after. An important premonitory sign is persistent precordial pain in the absence of pericardial friction. Cardiokinetic therapy was used in 70% of the CR cases examined here. Over the past decade, the frequency of CR secondary to AMI has risen appreciably and it is hypothesised that this increase may have been influenced by the readiness with which cardiokinetics are employed now during AMI, often in very high doses. Particularly in the case of patients at high CR risk, it is considered that cardiokinetic therapy should only be employed in cases of clear cardiac insufficiency, in small, fragmented doses and after diuretics and vasodilators have proved ineffective. Such patients can also usefully be transferred to specialist wards for emergency surgery or preventive infarctectomy.