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[Cardiac rupture in acute myocardial infarct. Presentation of 20 postmortem cases]
Insights
Cardiac rupture is a fatal complication of acute myocardial infarction (AMI). Key risk factors include hypertension, smoking, and diabetes, often presenting with chest pain and conduction disturbances.
Area of Science:
- Cardiology
- Pathology
Context:
- Coronary Care Units have reduced arrhythmia mortality in acute myocardial infarction (AMI).
- Cardiogenic shock and cardiac rupture are now leading causes of in-hospital death post-AMI.
Purpose:
- To characterize the anatomoclinical features of cardiac rupture in AMI patients.
- To identify risk factors for timely diagnosis of cardiac rupture, a cause of sudden death.
Summary:
- A postmortem study of 300 AMI cases identified 20 instances of cardiac rupture.
- Common risk factors included hypertension (75%), smoking (65%), and diabetes (55%).
- Free wall rupture (70%) and ventricular septal rupture (30%) were observed, with hemopericardium in all cases.
Impact:
- Findings aid in the early identification of patients at risk for cardiac rupture.
- Understanding these factors can potentially improve management strategies for AMI complications.
Abstract:
With the advancement of the Coronary Care Units in the past three decades, there had been an important reduction in mortality secondary to arrhythmias in acute myocardial infarction (AMI): been now days, cardiogenic shock and cardiac rupture the first and second causes of in-hospital death in these patients. The purpose of this report is to know the anatomoclinical characteristics in our hospital of cardiac rupture and to look for risk factors that may be considered to diagnose at the precise time this complication that might cause sudden death secondary to hemodynamic and electromechanical changes. From 300 postmortem cases with AMI proved clinical, and by anatomopathological studies, 20 cases with cardiac rupture were obtained, among which: 11 (55%) were males with an average age of 61.7 years and 9 (45%) females, with an average age of 60 years. The following coronary risk factors were detected: systemic hypertension in 15 (75%) cases; cigarette smoking in 13 (65%) cases and diabetes mellitus in 11 (55%) cases. Long lasting or recurrent history of chest pain previous to death was present in 14 (70%) cases. Conduction disturbances were detected in 13 (65%) cases; among them, 7 (35%) had third degree heart block in whom permanent pacemaker was inserted; 4 (20%) had CRBBB and 2 (10%) ASB. The average heart weight was 478 gr. in males and 434 gr. in females. Evidence of an old MI was present in 7 (35%) cases. All patients had transmural MI. Free cardiac wall rupture was seen in 14 (70%) cases and from the ventricular septum, 6 (30%) cases. Hemopericardium was present in all cases (100%) with an average amount of 425 ml of blood. Pericarditis in 3 (15%). The average time of evolution since the beginning of the AMI until death were 4 days and the main causes of death were cardiogenic shock in 17 (85%) and congestive heart failure in 3 (15%).