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Na CY. Surgical Outcome of Postinfarction Left Ventricular Free Wall Rupture. Tex Heart Inst J 2024; 51:238213. [PMID: 38291908 DOI: 10.14503/thij-23-8213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Left ventricular free wall rupture (LVFWR) is a rare and fatal complication after acute myocardial infarction. Early recognition and aggressive treatment are recommended. METHODS Between August 1999 and February 2023, 11 patients aged between 64 and 79 years developed LVFWR after acute myocardial infarction (mean interval, 3.5 days). Three patients had active bleeding (blowout-type LVFWR), and the other 8 patients experienced the oozing or sealed state. Eight patients were treated using a sutureless technique with Teflon felt and glue, 2 patients were treated using the primary suture closure technique, and 1 was treated using both the primary suture and the sutureless technique with Teflon felt and glue. RESULTS One patient died in the operating room as a result of bleeding. Cardiovascular stability and hemostasis were achieved in the other 10 patients. There were 3 early deaths (all 3 cases as a result of area bleeding; 1 was treated with primary suture, 2 with sutureless glue). Three patients received percutaneous coronary intervention before discharge. All 8 remaining patients survived and were discharged. Three patients were lost to follow-up. The follow-up period ranged from 2 to 97 months, with 4 patients exhibiting New York Heart Association class I symptoms and 1 exhibiting New York Heart Association class II symptoms. CONCLUSION Optimal surgical treatment for postinfarction LVFWR remains controversial. The sutureless technique may be a promising strategy for treating postinfarction LVFWR.
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Affiliation(s)
- Chan-Young Na
- Department of Thoracic and Cardiovascular Surgery, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, South Korea
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2
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Clinical Manifestation of Cardiac Rupture in Patients with ST-Segment Elevation Myocardial Infarction: Early Versus Late Primary Percutaneous Coronary Intervention. Glob Heart 2022; 17:69. [PMID: 36199564 PMCID: PMC9524297 DOI: 10.5334/gh.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Cardiac rupture is one of the fatal complications of ST-Segment Elevation Myocardial Infarction (STEMI) in the primary percutaneous coronary intervention (PPCI) era. The present study aims to identify risk factors of cardiac rupture among patients suffering from STEMI, treated with early and late PPCI. Methods: This is a multicenter retrospective cohort study involving STEMI patients with cardiac rupture (CR group), matched with STEMI patients without CR (control group) in a 1:5 ratio. They were divided into the early (≤ 6 h) and the late (> 6 h) PCI groups. Multivariable logistic regression was utilized to identify risk factors for cardiac rupture. Results: Seventy-four patients in the CR and 370 in the control group were included. Multivariable regression identified lateral infarction (OR = 11.89, 95% CI 2.22–63.81, p < 0.01) in the early PCI phase as a significant risk factor for cardiac rupture. Thrombolysis in myocardial infarction (TIMI) grade 0-1 (early PCI: OR = 4.16, 95% CI 1.33-13.0, p = 0.01; late PCI: OR = 4.46, 95% CI 1.59–12.54, p < 0.01) was a risk factor for both early and late PCI groups. In contrast, TIMI grade 2 was associated with a higher rupture risk within the late (OR = 16.87, 95% CI 3.83–74.19, p < 0.001) but not for the early (OR = 5.44, 95% CI 0.76–39.07, p = 0.09) PCI groups. STEMI combined with Killip IV was associated with a higher rupture risk for the late PCI group (OR = 1.43, 95% CI 1.03–1.99, p = 0.04). Intra-aortic balloon pump (IABP) was protective against cardiac rupture within early PPCI (OR = 0.18, 95% CI 0.04–0.89, p = 0.04). In contrast, glycoprotein IIb/IIIa inhibitors were associated with lower rupture risks in both the early and late groups (early PCI: OR = 0.38, 95% CI 0.17–0.87, p = 0.02; late PCI: OR = 0.33, 95% CI 0.15–0.75, p < 0.01). Conclusions: No reflow or slow blood flow is associated with a higher risk of cardiac rupture in early and late PCI patients. Glycoprotein IIb/IIIa inhibitors are beneficial in preventing heart rupture, and the use of IABP in early PPCI is also helpful in preventing heart rupture.
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3
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Koeda Y, Itoh T, Ishikawa Y, Morino Y, Mizutani T, Ako J, Nakano M, Yoshioka K, Ikari Y, Inami S, Sakuma M, Taguchi I, Ishikawa T, Sugimura H, Sugi K, Matsumoto K, Mitarai T, Kunishima T, Akashi YJ, Nomura T, Fukushi K, Yoshino H. A multicenter study on the clinical characteristics and risk factors of in-hospital mortality in patients with mechanical complications following acute myocardial infarction. Heart Vessels 2020; 35:1060-1069. [PMID: 32239276 DOI: 10.1007/s00380-020-01586-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/13/2020] [Indexed: 12/22/2022]
Abstract
Mechanical complications (MCs) following acute myocardial infarction (AMI), such as ventricular septal rupture (VSR), free-wall rupture (FWR), and papillary muscle rupture (PMR), are fatal. However, the risk factors of in-hospital mortality among patients with MCs have not been previously reported in Japan. The purpose of this study was to evaluate the prognostic factors of in-hospital mortality in these patients. The study cohort consisted of 233 consecutive patients with MCs from the registry of 10 facilities in the Cardiovascular Research Consortium-8 Universities (CIRC-8U) in East Japan between 1997 and 2014 (2.3% of 10,278 AMI patients). The authors conducted a retrospective observational study to analyse the correlation between the subtypes of MCs with in-hospital mortality, clinical data, and medical treatment. We observed a decreasing incidence of MC (1997-2004: 3.7%, 2005-2010: 2.1%, 2011-2014: 1.9%, p < 0.001). In-hospital mortality among patients with MCs was 46%. Thirty-three percent of patients with MCs were not able to undergo surgical repair due to advanced age or severe cardiogenic shock. In-hospital mortality among patients who had undergone surgical repair was 29% (VSR: 21%, FWR: 33%, PMR: 60%). In patients with MCs, hazard ratio for in-hospital mortality according to multivariate analysis of without surgical repair was 5.63 (95% CI 3.54-8.95). In patients with surgical repair, the hazard ratios of blow-out-type FWR (5.53, 95% confidence interval (CI) 2.22-13.76), those with renal dysfunction (3.11, 95% CI 1.37-7.05), and those receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) (3.79, 95% CI 1.81-7.96) were significantly high. Although primary percutaneous coronary intervention (PCI) is associated with decreased incidence of MCs, high in-hospital mortality persisted in patients with MCs that also presented with renal dysfunction and in those requiring VA-ECMO. Early detection and surgical repair of MCs are essential.
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Affiliation(s)
- Yorihiko Koeda
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan
| | - Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan.
| | - Yu Ishikawa
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan
| | - Tomohiro Mizutani
- Division of Cardiology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Junya Ako
- Division of Cardiology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Masataka Nakano
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Tokyo, Japan
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Tokyo, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Tokyo, Japan
| | - Shu Inami
- Department of Cardiovascular Medicine, Dokkyo Medical University, Shimotsuga, Japan
| | - Masashi Sakuma
- Department of Cardiovascular Medicine, Dokkyo Medical University, Shimotsuga, Japan
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hiroyuki Sugimura
- Division of Cardiology, Nikko Medical Center, Dokkyo Medical University, Nikko, Japan
| | - Keiki Sugi
- Division of Cardiology, Saitama Medical University, Saitama, Japan
| | - Kazuo Matsumoto
- Division of Cardiology, Saitama Medical University, Saitama, Japan
| | - Takanobu Mitarai
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoyuki Kunishima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takahiro Nomura
- Division of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kei Fukushi
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Hideaki Yoshino
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
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Marto JP, Kauppila LA, Jorge C, Calado S, Viana-Baptista M, Pinho-E-Melo T, Fonseca AC. Intravenous Thrombolysis for Acute Ischemic Stroke After Recent Myocardial Infarction: Case Series and Systematic Review. Stroke 2019; 50:2813-2818. [PMID: 31436141 DOI: 10.1161/strokeaha.119.025630] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background and Purpose- The safety of IV r-tPA (intravenous tissue-type plasminogen activator) for acute ischemic stroke (AIS) treatment after recent myocardial infarction (MI) is still a matter of debate. We studied the safety of delivering IV r-tPA to AIS patients with a MI within the preceding 3 months. Methods- Retrospective review of consecutive AIS admitted to 2 tertiary university hospitals' and systematic literature review for AIS patients with history of MI in the previous 3 months. Patients were divided into 2 groups: treated or not treated with standard IV r-tPA dose for AIS. Cardiac complications (cardiac rupture/tamponade, intracardiac thrombus embolization, or life-threatening arrhythmias) were compared between groups and assessed by type of MI (non-ST-segment-elevation myocardial infarction [STEMI], or STEMI) and time elapsed between vascular events. Results- One hundred and two patients were included; 46 (45.1%) were derived from literature review. Median age (interquartile range) was 64 (53-75) years old, and 69 (67.6%) were men. Forty-seven (46.1%) received IV r-tPA. In the treated group, 25 (53.2%) and 23 (48.9%) patients had, respectively, concurrent AIS and MI and STEMI, in comparison with 12 (21.8%; P=0.002) and 36 (65.5%; P=0.110) patients in the nontreated. Four (8.5%) IV r-tPA-treated patients died from confirmed or presumed cardiac rupture/ tamponade, all with a STEMI in the week preceding stroke. This complication occurred in 1 (1.8%) patients in the nontreated group (P=0.178). There were no differences in thrombus embolization (1 [2.1%) versus 2 [3.6]; P=1.000) and life-threatening arrhythmias (3 [6.4%) versus 7 [12.7]; P=0.335). No non-STEMI patients receiving IV r-tPA had cardiac complications. Conclusions- In patients with AIS and recent or concurrent MI, MI type and the time elapsed between the 2 events should be taken into consideration when deciding to deliver IV r-tPA. Although recent non-STEMI or concurrent events seem safe, STEMI in the week preceding stroke should prompt caution. The low number of events and publication bias may have influenced our conclusions.
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Affiliation(s)
- João Pedro Marto
- From the Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal (J.P.M., S.C., M.V.-B.)
- CEDOC - Nova Medical School, Universidade Nova de Lisboa, Portugal (J.P.M., S.C., M.V.-B.)
| | - Linda Azevedo Kauppila
- Stroke Unit, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Portugal (L.A.K., T.P.-e.-M., C.F.)
| | - Cláudia Jorge
- Department of Cardiology, Hospital de Santa Maria, University of Lisboa, Portugal (C.J.)
| | - Sofia Calado
- From the Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal (J.P.M., S.C., M.V.-B.)
- CEDOC - Nova Medical School, Universidade Nova de Lisboa, Portugal (J.P.M., S.C., M.V.-B.)
| | - Miguel Viana-Baptista
- From the Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal (J.P.M., S.C., M.V.-B.)
- CEDOC - Nova Medical School, Universidade Nova de Lisboa, Portugal (J.P.M., S.C., M.V.-B.)
| | - Teresa Pinho-E-Melo
- Stroke Unit, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Portugal (L.A.K., T.P.-e.-M., C.F.)
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal (T.P.-e.-M., C.F.)
| | - Ana Catarina Fonseca
- Stroke Unit, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Portugal (L.A.K., T.P.-e.-M., C.F.)
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal (T.P.-e.-M., C.F.)
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5
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Tagawa T, Sakuraba S. Intraoperative diagnosis of an unsuspected ruptured left ventricular aneurysm using transesophageal echocardiography: A case report. Clin Case Rep 2019; 7:37-39. [PMID: 30656004 PMCID: PMC6333063 DOI: 10.1002/ccr3.1902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/11/2018] [Accepted: 10/16/2018] [Indexed: 11/23/2022] Open
Abstract
Transesophageal echocardiography (TEE) enables a more accurate visualization of left ventricular posterior aneurysms than transthoracic echocardiography due to the close proximity of the esophagus to the posterior ventricular wall. Therefore, TEE is essential for the accurate diagnosis of posterior aneurysm, particularly in urgent settings where preoperative assessments may be insufficient.
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Affiliation(s)
- Tsuyoshi Tagawa
- Division of Clinical AnesthesiaMie University HospitalTsuJapan
| | - Shigeki Sakuraba
- Department of AnesthesiologyClinical Care MedicineKanagawa Dental CollegeKanagawaJapan
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6
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Hua J, Liu Z, Liu Z, An D, Lai W, Zhan Q, Zeng Q, Ren H, Xu D. Metformin Increases Cardiac Rupture After Myocardial Infarction via the AMPK-MTOR/PGC-1α Signaling Pathway in Rats with Acute Myocardial Infarction. Med Sci Monit 2018; 24:6989-7000. [PMID: 30275441 PMCID: PMC6180847 DOI: 10.12659/msm.910930] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Cardiac rupture often occurs after acute myocardial infarction due to complex and unclear pathogenesis. This study investigated whether metformin increases the incidence of cardiac rupture after myocardial infarction through the AMPK-MTOR/PGC-1α signaling pathway. Material/Methods An acute myocardial infarction (MI) mouse model was established. A series of experiments involving RT-qPCR, Western blot, TUNEL staining, and Masson staining were performed in this study. Results Myocardial infarction occurred, resulting in the cardiac rupture, and the expression level of PGC-1α increased in the cardiac myocardium. Meanwhile, the proportion of myocardial NT-PGC-1α/PGC-1α decreased. The expression level of myocardial PGC-1α in MI mice with cardiac rupture after MI was significantly higher than that in the mice without cardiac rupture, and the ratio of myocardial NT-PGC-1α/PGC-1α was low. In addition, increasing the dose of metformin significantly increased the incidence of cardiac rupture after myocardial infarction in MI mice. High-dose metformin caused cardiac rupture in MI mice. Moreover, high-dose metformin (Met 2.0 nM) reduces the proportion of NT-PGC-1α/PGC-1α in primary cardiomyocytes of SD mice (SD-NRVCs [Neonatal rat ventricular cardiomyocytes]), and its effect was inhibited by Compound C (AMPK inhibitor). Further, after 3 days of treatment with high-dose metformin in MI mice, myocardial fibrin synthesis decreased and fibrosis was significantly inhibited. Meanwhile, cardiomyocyte apoptosis increased significantly. With the increase in metformin concentration, the expression level of myocardial LC3b gradually increased in MI mice, suggesting that metformin enhances the autophagy of cardiomyocytes. Conclusions These results suggest that metformin increases cardiac rupture after myocardial infarction through the AMPK-MTOR/PGC-1α signaling pathway.
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Affiliation(s)
- Jinghai Hua
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Key Laboratory for Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, Guangdong, China (mainland)
| | - Zhanghua Liu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Key Laboratory for Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, Guangdong, China (mainland)
| | - Zuheng Liu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Key Laboratory for Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, Guangdong, China (mainland)
| | - Dongqi An
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Key Laboratory for Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, Guangdong, China (mainland)
| | - Wenyan Lai
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Key Laboratory for Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, Guangdong, China (mainland)
| | - Qiong Zhan
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Key Laboratory for Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, Guangdong, China (mainland)
| | - Qingchun Zeng
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Key Laboratory for Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, Guangdong, China (mainland)
| | - Hao Ren
- Key Laboratory for Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, Guangdong, China (mainland).,Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Dingli Xu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Key Laboratory for Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, Guangdong, China (mainland)
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7
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Abstract
Patients with their first myocardial infarction (MI), who present to the emergency department many hours after the onset of chest pain, who appear to be improving but suddenly develop new chest pain and unexpected hypotension (with or without signs of cardiac tamponade), should be suspected of having ventricular free wall rupture (VFWR). The mainstay of treatment is surgery. These patients may be managed with the administration of fluids, cautious use of inotropes and echocardiographic scanning, which should be performed on an emergent basis, while being prepared to be moved to the emergency surgical suite. However, at no cost should surgery be delayed. This paper reviews the current literature of VFWR after MI, a condition which remains difficult to diagnose, in many aspects, to this day. The review examines the historical background, incidence, postulated risk factors, clinical presentation, investigations and management.
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Affiliation(s)
| | - N Nimbkar
- Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
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Hensen H, Spaander F, Bax M, Koppen H. Fatal hemopericardium after intravenous recombinant transplasminogeen activator (rt-PA) for acute ischemic stroke. Am J Emerg Med 2016; 34:2462.e5-2462.e6. [PMID: 27358044 DOI: 10.1016/j.ajem.2016.05.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Hanna Hensen
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands.
| | - Fianne Spaander
- Department of Neurology, Onze Lieve Vrouwen Gasthuis, Amsterdam, The Netherlands
| | - Matthijs Bax
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Hille Koppen
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
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Honda S, Asaumi Y, Yamane T, Nagai T, Miyagi T, Noguchi T, Anzai T, Goto Y, Ishihara M, Nishimura K, Ogawa H, Ishibashi-Ueda H, Yasuda S. Trends in the clinical and pathological characteristics of cardiac rupture in patients with acute myocardial infarction over 35 years. J Am Heart Assoc 2014; 3:e000984. [PMID: 25332178 PMCID: PMC4323797 DOI: 10.1161/jaha.114.000984] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background There is little known about whether the clinical and pathological characteristics and incidence of cardiac rupture (CR) in patients with acute myocardial infarction (AMI) have changed over the years. Methods and Results The incidence and clinical characteristics of CR were investigated in patients with AMI, who were divided into 3 cohorts: 1977–1989, 1990–2000, and 2001–2011. Of a total of 5699 patients, 144 were diagnosed with CR and 45 survived. Over the years, the incidence of CR decreased (1977–1989, 3.3%; 1990–2000, 2.8%; 2001–2011, 1.7%; P=0.002) in association with the widespread adoption of reperfusion therapy. The mortality rate of CR decreased (1977–1989, 90%; 1990–2000, 56%; 2001–2011, 50%; P=0.002) in association with an increase in the rate of emergent surgery. In multivariable analysis, first myocardial infarction, anterior infarct, female sex, hypertension, and age >70 years were significant risk factors for CR, whereas impact of hypertension on CR was weaker from 2001 to 2011. Primary percutaneous coronary intervention (PPCI) was a significant protective factor against CR. In 64 autopsy cases with CR, myocardial hemorrhage occurred more frequently in those who underwent PPCI or fibrinolysis than those who did not receive reperfusion therapy (no reperfusion therapy, 18.0%; fibrinolysis, 71.4%; PPCI, 83.3%; P=0.001). Conclusions With the development of medical treatment, the incidence and mortality rate of CR have decreased. However, first myocardial infarction, anterior infarct, female sex, and old age remain important risk factors for CR. Adjunctive cardioprotection against reperfusion‐induced myocardial hemorrhage is emerging in the current PPCI era.
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Affiliation(s)
- Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.) Department of Advanced Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan (S.H., S.Y.)
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Takafumi Yamane
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Tadayoshi Miyagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Yoichi Goto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Masaharu Ishihara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (K.N.)
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.) Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (H.O.)
| | - Hatsue Ishibashi-Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.) Department of Advanced Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan (S.H., S.Y.)
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10
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Alshehri HZ, Momenah TS, AlBaradai A, Sallam A, Alassal MA, Lawand S. Successful percutaneous closure of post myocardial infarction left ventricular ruptured pseudoaneurysm after failed surgical repair. J Cardiol Cases 2014; 9:154-157. [PMID: 30546789 DOI: 10.1016/j.jccase.2013.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 12/05/2013] [Accepted: 12/23/2013] [Indexed: 11/17/2022] Open
Abstract
Left ventricular pseudoaneurysms occur as a consequence of left ventricular free wall rupture contained by pericardium. This clinical situation is an uncommon but lethal complication of acute myocardial infarction. Surgery usually is the preferred therapeutic option but is associated with significant perioperative risk. We present a case of successful percutaneous closure of left ventricular ruptured pseudoaneurysm post myocardial infarction in a patient who failed two previous surgical repairs. <Learning objective: Recently there has been some published experience regarding percutaneous closure of left ventricle pseudoaneurysm as an alternative to surgical repair in patients at high operative risk. To the best of our knowledge this is the first reported case that demonstrates successful percutaneous closure of ruptured pseudoaneurysm after failed surgical repairs.>.
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Affiliation(s)
- Haliah Z Alshehri
- Adult Cardiology Department, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tariq S Momenah
- Pediatric Cardiology Department, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz AlBaradai
- Cardiac Surgery Department, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ayman Sallam
- Cardiac Surgery Department, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammad A Alassal
- Cardiac Surgery Department, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Samih Lawand
- Adult Cardiology Department, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
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11
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Dogan KH, Demirci S, Tavli L, Buken B. Pseudoaneurysm originating from left ventricle aneurysm: an autopsy case and review of literature. J Forensic Leg Med 2013; 20:941-3. [PMID: 24237794 DOI: 10.1016/j.jflm.2013.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 08/02/2013] [Accepted: 09/07/2013] [Indexed: 01/25/2023]
Abstract
Rupture of the free wall of the left ventricle is a catastrophic complication of acute myocardial infarction. Rarely, free wall rupture is contained by overlying adherent pericardium, producing a pseudoaneurysm of the left ventricle. In this report, a case of a left ventricular pseudoaneurysm due to a previous myocardial infarction is described. A 55-year-old woman had a severe chest pain 11 months prior to death. No cardiac investigation was performed. Three days prior to death, she suffered from fatigue and weakness, and had a witnessed sudden cardiac death. At autopsy, a 8.5 × 10 × 8 cm pseudoaneurysm of the left ventricle was found. There was severe coronary artery atherosclerosis. There were extensive adhesions between pericardium and pseudoaneurysm wall. The cause of death was attributed to heart failure and resulting arrhythmia. The case illustrates the rare event of left ventricular pseudoaneurysm first diagnosed at forensic autopsy.
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Affiliation(s)
- Kamil Hakan Dogan
- Department of Forensic Medicine, Faculty of Medicine, Selcuk University, Aleaddin Keykubat Campus, Selcuklu, 42075 Konya, Turkey.
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12
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Contained Left Ventricular Free Wall Rupture following Myocardial Infarction. Case Rep Crit Care 2012; 2012:467810. [PMID: 24804119 PMCID: PMC4010050 DOI: 10.1155/2012/467810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 11/27/2012] [Indexed: 11/17/2022] Open
Abstract
Rupture of the free wall of the left ventricle occurs in approximately 4% of patients with infarcts and accounts for approximately 20% of the total mortality of patients with myocardial infractions. Relatively few cases are diagnosed before death. Several distinct clinical forms of ventricular free wall rupture have been identified. Sudden rupture with massive hemorrhage into the pericardium is the most common form; in a third of the cases, the course is subacute with slow and sometimes repetitive hemorrhage into the pericardial cavity. Left ventricular pseudoaneurysms generally occur as a consequence of left ventricular free wall rupture covered by a portion of pericardium, in contrast to a true aneurysm, which is formed of myocardial tissue. Here, we report a case of contained left ventricular free wall rupture following myocardial infarction.
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13
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Ng R, Yeghiazarians Y. Post myocardial infarction cardiogenic shock: a review of current therapies. J Intensive Care Med 2011; 28:151-65. [PMID: 21747126 DOI: 10.1177/0885066611411407] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cardiogenic shock is often a devastating consequence of acute myocardial infarction (MI) and portends to significant mortality and morbidity. Despite improvements in expediting the time to treatment and enhancements in available medical therapy and reperfusion techniques, cardiogenic shock remains the most common cause of mortality following MI. Post-MI cardiogenic shock most commonly occurs as a consequence of severe left ventricular dysfunction. Right ventricular (RV) MI must also be considered. Mechanical complications including acute mitral regurgitation, ventricular septal rupture, and ventricular free-wall rupture can also lead to cardiogenic shock. Rapid diagnosis of cardiogenic shock and its underlying cause is pivotal to delivering definitive therapy. Intravenous vasoactive agents and mechanical support devices may temporize the patient's hemodynamic status until definitive therapy by percutaneous or surgical intervention can be performed. Despite prompt management, post-MI cardiogenic shock mortality remains high.
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Affiliation(s)
- Ramford Ng
- University of California, San Francisco, CA 94143, USA
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14
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López-Sendón J, Gurfinkel EP, Lopez de Sa E, Agnelli G, Gore JM, Steg PG, Eagle KA, Cantador JR, Fitzgerald G, Granger CB. Factors related to heart rupture in acute coronary syndromes in the Global Registry of Acute Coronary Events. Eur Heart J 2010; 31:1449-56. [PMID: 20231153 DOI: 10.1093/eurheartj/ehq061] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS To determine the incidence and factors associated with heart rupture (HR) in acute coronary syndrome (ACS) patients. METHODS AND RESULTS Among 60 198 patients, 273 (0.45%) had HR (free wall rupture, n = 118; ventricular septal rupture, n = 155). Incidence was 0.9% for ST-segment elevation myocardial infarction (STEMI), 0.17% for non-STEMI, and 0.25% for unstable angina. Hospital mortality was 58 vs. 4.5% in patients without HR (P < 0.001). The incidence was lower in STEMI patients with primary percutaneous coronary intervention (PCI) than in those without (0.7 vs. 1.1%; P = 0.01), but primary PCI was not independently related to HR in adjusted analysis (P = 0.20). Independent variables associated with HR included: ST-segment elevation (STE)/left bundle branch block; ST-segment deviation; female sex; previous stroke; positive initial cardiac biomarkers; older age; higher heart rate; systolic blood pressure/30 mmHg decrease. Conversely, previous MI and the use of low-molecular-weight heparin and beta-blockers during first 24 h were identified as protective factors for HR. CONCLUSION The incidence of HR is low in patients with ACS, although its incidence is probably underestimated. Heart rupture occurs more frequently in ACS with STE and is associated with high hospital mortality. A number of variables are independently related to HR.
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Affiliation(s)
- José López-Sendón
- Cardiology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28036 Madrid, Spain.
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15
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Bansal RC, Lin T, Shaker R, Rasi A, Jutzy KR, Razzouk A. A unique complication of a broken heart. Am J Med 2009; 122:910-2. [PMID: 19786158 DOI: 10.1016/j.amjmed.2009.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 06/25/2009] [Accepted: 06/25/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Ramesh C Bansal
- Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
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16
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Rasmussen S, Leth A, Kjøller E, Pedersen A. Cardiac rupture in acute myocardial infarction. A review of 72 consecutive cases. ACTA MEDICA SCANDINAVICA 2009; 205:11-6. [PMID: 760397 DOI: 10.1111/j.0954-6820.1979.tb05997.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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17
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Figueras J, Alcalde O, Barrabés JA, Serra V, Alguersuari J, Cortadellas J, Lidón RM. Changes in hospital mortality rates in 425 patients with acute ST-elevation myocardial infarction and cardiac rupture over a 30-year period. Circulation 2008; 118:2783-9. [PMID: 19064683 DOI: 10.1161/circulationaha.108.776690] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Possible changes in the incidence and outcome of cardiac rupture in patients with ST-elevation myocardial infarction over a long period of time have not been investigated. METHODS AND RESULTS The incidence of cardiac rupture in ST-elevation myocardial infarction patients and its mortality rate were investigated during a 30-year period divided into 5 intervals (1977 to 1982, 1983 to 1988, 1989 to 1994, 1995 to 2000, and 2001 to 2006). Of a total of 6678 consecutive patients, 425 experienced a free wall rupture (280 with cardiac tamponade: 227 with electromechanical dissociation and 53 with hypotension) or a septal rupture (145). After the exclusion of referrals from other centers (n=44), the incidence of definite cardiac rupture (septal rupture, anatomic evidence of free wall rupture, or electromechanical dissociation) declined progressively (6.2% in 1977 to 1982 to 3.2% in 2001 to 2006; P<0.001) in parallel with a progressive use of reperfusion therapy (0% to 75.1%; P<0.001). In addition, among patients with cardiac rupture, there was a progressive fall in the rate of death (94% to 75%; P<0.001) despite a trend toward increasing age (66+/-8 to 75+/-8 years; P<0.054) in conjunction with better control of systolic blood pressure at 24 hours (130+/-24 versus 110+/-18 mm Hg; P<0.001); an increased use of reperfusion therapy (0% to 59%; P<0.001), beta-blockers (0% to 45%; P<0.001), angiotensin-converting enzyme inhibitors (0% to 38%; P<0.001), and aspirin (0% to 96%; P<0.001); and a lower use of heparin (99% to 67%; P<0.001). CONCLUSIONS The decline in the incidence in cardiac rupture and its rate of death over the last 30 years appears to be associated with the increasing use of reperfusion strategies and adjunct medical therapy.
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Affiliation(s)
- Jaume Figueras
- Unitat Coronària, Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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18
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Yanagi D, Shirai K, Arimura T, Saito N, Mitsutake C, Mitsutake R, Hida S, Iwata A, Nishikawa H, Kawamura A, Miura SI, Saku K. Left ventricular oozing rupture following acute myocardial infarction. Intern Med 2008; 47:1803-5. [PMID: 18854633 DOI: 10.2169/internalmedicine.47.1164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe the case of an 85-year-old woman in whom pericardiocentesis, prolonged bed rest and blood pressure control were performed without surgery to successfully treat an oozing-type myocardial rupture due to myocardial infarction.
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Affiliation(s)
- Daizaburo Yanagi
- Department of Cardiology, Fukuoka University Medical School, Fukuoka
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19
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Bae H, Noh H, Cheon YJ. Ventricular wall rupture after myocardial infarction and cardiac arrest. Resuscitation 2007; 74:6-7. [PMID: 17379378 DOI: 10.1016/j.resuscitation.2007.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 12/21/2006] [Accepted: 01/02/2007] [Indexed: 10/23/2022]
Affiliation(s)
- Hyuna Bae
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, 911-1 Mokdong, YangCheon-ku, Seoul, Republic of Korea.
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20
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Jugdutt BI, Idikio H, Uwiera RRE. Therapeutic drugs during healing after myocardial infarction modify infarct collagens and ventricular distensibility at elevated pressures. Mol Cell Biochem 2007; 304:79-91. [PMID: 17487453 DOI: 10.1007/s11010-007-9488-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 04/14/2007] [Indexed: 11/25/2022]
Abstract
We investigated whether therapeutic drugs given during healing following acute myocardial infarction (AMI) modify infarct collagens and left ventricular (LV) distensibility. We treated dogs with drugs from major classes (i.e., indomethacin, ibuprofen, captopril, enalapril, verapamil, amlodipine, propranolol, isosorbide dinitrate [ISDN] and digoxin) between day 2 and 6 weeks and measured hemodynamics, LV remodeling and function during healing over 6 weeks after transmural anterior AMI, and regional collagens, LV distensibility under increasing pressure, rupture threshold (RT), and topography at 6 weeks. Relative to sham, AMI controls showed infarct zone (IZ) expansion and thinning, 9.3-fold increase in IZ collagen, LV dilation and dysfunction, and no change in distensibility and RT. Relative to controls, indomethacin as well as enalapril, captopril and amlodipine decreased IZ collagen. Infarct expansion was attenuated by ibuprofen, captopril, amlodipine and ISDN but augmented by indomethacin. Infarct thinning was prevented by captopril, amlodipine and ISDN but enhanced by indomethacin. Importantly, indomethacin and enalapril enhanced LV distensibility and lowered RT. Distensibility correlated positively with IZ type III collagen and negatively with type I/III collagen ratio and pyridinoline cross-links whereas RT correlated positively with IZ type I collagen. Systolic volume and ejection fraction deteriorated with indomethacin but were improved or preserved with other therapies. The results demonstrate that different therapeutic drugs may produce different effects on IZ collagens during healing post-AMI: drugs that attenuate or adversely alter IZ collagens also enhance LV distensibility, augment adverse remodeling and lower RT, suggesting that testing for these effects post-AMI is warranted.
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Affiliation(s)
- Bodh I Jugdutt
- 2C2 Walter MacKenzie Health Sciences Centre, Division of Cardiology, Department of Medicine and Cardiovascular Research Group, University of Alberta, Edmonton, AB, Canada, T6G 2R7.
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21
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Uno K, Takenaka K, Asada K, Ebihara A, Sasaki K, Komuro T, Nagai R, Motomura N, Ono M, Takamoto S. Diagnosis of Subacute Cardiac Rupture by Contrast Echocardiography. J Am Soc Echocardiogr 2006; 19:1401.e9-1401.e11. [DOI: 10.1016/j.echo.2006.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Indexed: 10/23/2022]
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22
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Clarot F, Vaz E, Vicomte C, Gricourt C, Papin F, Proust B. Sudden death from a "broken heart" in a young woman. J Forensic Leg Med 2006; 14:172-4. [PMID: 16914361 DOI: 10.1016/j.jcfm.2006.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A case of ruptured myocardial infarct in a young woman with no previous medical history is presented, as well as a review of the literature and forensic aspects are discussed.
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Affiliation(s)
- F Clarot
- Rouen University Hospital, Department of Forensic Medicine, CHU Rouen-Charles, Nicolle-Rouen, France.
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23
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Chen SSM, Ruengsakulrach P, Dick RJL, Buxton BF. Post-infarct left ventricular free wall rupture-not always a lethal complication of acute myocardial infarction. Heart Lung Circ 2005; 13:26-30. [PMID: 16352164 DOI: 10.1016/j.hlc.2004.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Post-myocardial infarction cardiac rupture is an important complication and cause of death in the period following myocardial infarction. It is rarely diagnosed before death. However, early diagnosis is crucial as successful treatment is possible with surgery. A successful outcome is sometimes compromised by difficult anatomy or an extensive infarct. Presentation, diagnosis and treatment of cardiac rupture is reviewed in this article, and is illustrated by five cases of cardiac rupture.
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Affiliation(s)
- Sylvia S M Chen
- Department of Cardiology, Epworth Hospital, Melbourne, Vic., Australia.
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24
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Okino S, Nishiyama K, Ando K, Nobuyoshi M. Thrombolysis Increases the Risk of Free Wall Rupture in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention. J Interv Cardiol 2005; 18:167-72. [PMID: 15966920 DOI: 10.1111/j.1540-8183.2005.04110.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
In spite of the progress made in acute angiographic evaluation and obtaining durable reperfusion of acute myocardial infarction (AMI) in the past two decades, cardiac free wall rupture (FWR) is still one of the causes of mortality following AMI. In this study, we evaluated the role of thrombolysis in the risk of FWR in AMI patients treated with acute percutaneous coronary intervention (PCI). Among 3,786 consecutive AMI patients seen between 1985 and 2003, 3,066 patients were treated by primary PCI or rescue PCI, with or without additional thrombolysis. FWR occurred in 24 of 3,066 patients (0.8%) treated by PCI; female gender (1.4% vs 0.6%, P=0.001), age >75 years, (1.4% vs 0.6%, P=0.001) left main coronary artery (LMCA)-related infarction, (4.5% vs all other arteries, P=0.015), and thrombolytic use (3.1% vs 0.4%, P<0.001) were all associated with higher rates of FWR by univariate analysis. In patients treated with PCI and thrombolysis, FWR occurred in 2.7% with optimal PCI results but in only 4.9% if PCI was unsuccessful (P=NS). The incidence of FWR in patients with optimal PCI without thrombolysis was 0.4% (P<0.001). Multivariable analysis identified thrombolytic use (odds ratio [OR]: 8.49, 95% confidence interval [CI]: 3.66-19.7, P<0.001), LMCA-related infarction (OR: 7.06, 95% CI: 1.89-26.4, P=0.004), and female gender (OR: 3.02, 95% CI: 1.27-7.21, P=0.013) as independent predictors of FWR. Thrombolysis is one of the contributing causes of FWR in AMI patients undergoing PCI, even when PCI is successful.
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Affiliation(s)
- Shinichi Okino
- Division of Cardiology, Funabashi Municipal Medical Center, Chiba, Japan.
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25
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Lakkireddy DR, Khan IA, Nair CK, Korlakunta HL, Sugimoto JT. Pseudo-pseudoaneurysm of the left ventricle: a rare complication of acute myocardial infarction--a case report and literature review. Angiology 2005; 56:97-101. [PMID: 15678263 DOI: 10.1177/000331970505600114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rupture of the cardiac wall is usually a fatal complication of acute myocardial infarction within the first 2 weeks. However, in certain cases a ruptured ventricular wall is contained by overlying adherent pericardium called pseudoaneurysm, whereas a true aneurysm is one that is caused by scar formation resulting in thinning of the myocardium. The patients with pseudoaneurysm may survive until the aneurysm ruptures. In exceedingly rare instance, the rupture of the myocardium is not transmural but remains circumscribed within the ventricular wall itself, but in communication with the ventricular cavity. This finding is defined as pseudo-pseudoaneurysm. The authors report a case of postinfarction posterobasal pseudo-pseudoaneurysm along with review of the literature on the subject.
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26
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Wehrens XHT, Doevendans PA. Cardiac rupture complicating myocardial infarction. Int J Cardiol 2004; 95:285-92. [PMID: 15193834 DOI: 10.1016/j.ijcard.2003.06.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2003] [Revised: 06/03/2003] [Accepted: 06/09/2003] [Indexed: 11/21/2022]
Abstract
Rupture of the ventricular free wall is a leading cause of death in patients with acute myocardial infarction (MI). There are a number of risk indicators that are associated with cardiac rupture, such as female gender, old age, hypertension, and first MI. Typical symptoms of cardiac rupture are recurrent or persistent chest pain, syncope, and distension of jugular veins. Electrocardiographic signs may include sinus tachycardia, new Q-waves in 2 or more leads, persistent or recurrent ST segment elevation, deviation of expected evolutionary T-wave pattern, and electromechanical dissociation in end-stage cases. Once patients at risk have been identified using clinical symptoms and electrocardiographic signs, a fast and sensitive diagnostic test to confirm cardiac rupture is transthoracic echocardiography (TTE). New insights in the etiology of subacute myocardial rupture suggests that defective cardiac remodeling may predispose the heart for rupture. The matrix metalloproteinase (MMP) system has been shown to play an important role in cardiac extracellular matrix (ECM) remodeling and cardiac rupture. Current therapy of cardiac rupture consists mainly of surgery, and conservative management with hemodynamic monitoring, prolonged bed rest, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors in selected cases.
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Affiliation(s)
- Xander H T Wehrens
- Center for Molecular Cardiology, College of Physicians and Surgeons of Columbia University, 630W 168th Street, P and S 9-401, New York, NY 10032, USA
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27
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Ikeda N, Yasu T, Kubo N, Hirahara T, Sugawara Y, Kobayashi N, Hashimoto S, Tsuruya Y, Fujii M, Saito M. Effect of Reperfusion Therapy on Cardiac Rupture After Myocardial Infarction in Japanese. Circ J 2004; 68:422-6. [PMID: 15118282 DOI: 10.1253/circj.68.422] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiac rupture after acute myocardial infarction (AMI) is unpredictable and almost always fatal, so the present study reviewed all the clinical characteristics of patients with cardiac rupture to determine if its occurrence can be predicted. METHODS AND RESULTS The clinical characteristics of 1,296 consecutive AMI patients from January 1992 to February 2002 were retrospectively evaluated using multi-logistic analysis. Cardiac rupture occurred in 45 patients (3.5%), comprising left ventricular free wall rupture (n=23), ventricular septal perforation (n=20) and papillary muscle rupture (n=2). Early-phase rupture (within 72 h after AMI onset) was associated with anterior infarction. Of the 45 patients who experienced ruptures, 24 (53.3%) survived to discharge; 21 (46.6%) of the 45 ruptures occurred after admission. Successful reperfusion therapy was performed within 24 h for 840 patients. The incidence of rupture was significantly lower for reperfused patients than for non-reperfused patients (0.6% vs 3.5%, respectively; p<0.01). Peak C-reactive protein concentration was a reliable predictor of late-phase rupture (p=0.01), but not of early-phase rupture. CONCLUSIONS Reperfusion therapy appears to aid in the prevention of cardiac rupture, especially late-phase rupture.
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Affiliation(s)
- Nahoko Ikeda
- Cardiovascular Division, First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School, Saitama, Japan
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28
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Canovas SJ, Lim E, Dalmau MJ, Bueno M, Buendía J, Hornero F, Gil O, Garcia R, Paya R, Perez J, Echanove I, Montero J. Midterm clinical and echocardiographic results with patch glue repair of left ventricular free wall rupture. Circulation 2003; 108 Suppl 1:II237-40. [PMID: 12970239 DOI: 10.1161/01.cir.0000089042.80722.7a] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular free wall rupture (LVFWR) is a dramatic complication after myocardial infarction. We present our mid-term clinical and echocardiographic results of LVFWR with an epicardial patch without cardiopulmonary bypass. METHODS From February 1993 to May 2001, 17 patients underwent surgery for LVFWR. The mean age+/-SD of 12 males and 5 females was 68+/-10 years. All patients presented for emergency surgery with cardiac tamponade confirmed on echocardiography. After opening the chest and identification of the site of rupture, a Goretex patch was fashioned and applied with enbucrilate surgical glue. RESULTS Effective control of bleeding was achieved in all cases. There were no on-table deaths. The operative (30 day) mortality was 23.5% (4/17). One death occurred because of patch failure, two because of cardiogenic shock, and one from pneumonia. On follow-up at a median of 2.2 years (interquartile range, 1.1 to 4.3 years), two further deaths occurred, one from myocardial infarction and another of undetermined etiology. Echocardiography did not reveal any evidence of restriction to left ventricular free wall motion. CONCLUSIONS Patch glue repair is expedient, simple and effective; with no adverse effects on mid-term ventricular dynamics. In view of superior published results to infarctectomy and repair with extra corporeal circulation, it should be considered to be the initial procedure of choice for the surgical repair of LVFWR.
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Affiliation(s)
- Sergio J Canovas
- Department of Cardiac Surgery, University General Hospital, Valencia, Spain.
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29
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Birnbaum Y, Chamoun AJ, Anzuini A, Lick SD, Ahmad M, Uretsky BF. Ventricular free wall rupture following acute myocardial infarction. Coron Artery Dis 2003; 14:463-70. [PMID: 12966268 DOI: 10.1097/00019501-200309000-00008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Ventricular free wall rupture remains a dreaded complication of acute myocardial infarction. A dramatic fatal presentation is not universal and if recognized early, especially in its sub-acute form, a therapeutic intervention may be lifesaving. Changing trends in its natural history and the previously described pathological subtypes have emerged since the advent of thrombolysis. Although frequently unpredictable, certain clinical, echocardiographic and electrocardiographic signs should suggest the diagnosis. Moreover, knowledge of predisposing risk factors and a high index of suspicion are helpful in early recognition of this complication. In recent years, several different therapeutic approaches have been described including percutaneous seals and surgical mechanical closure of ventricular free wall rupture. In this review, we sought to highlight established and debatable aspects of this pathology to hopefully enhance prompt diagnosis and treatment by all clinicians caring for patients suffering acute myocardial infarction.
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Affiliation(s)
- Yochai Birnbaum
- Division of Cardiology, Department of Internal Medicine, University of Texas Medical Branch, 5106 John Sealy Annex, 301 University Boulevard, Galveston, TX 77555-0553, USA.
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Yip HK, Wu CJ, Chang HW, Wang CP, Cheng CI, Chua S, Chen MC. Cardiac rupture complicating acute myocardial infarction in the direct percutaneous coronary intervention reperfusion era. Chest 2003; 124:565-71. [PMID: 12907544 DOI: 10.1378/chest.124.2.565] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cardiac rupture, an uncommon yet catastrophic complication after acute myocardial infarction (AMI), has been studied primarily in the prethrombolytic and thrombolytic therapy eras but not in the direct percutaneous coronary intervention (d-PCI) reperfusion therapy era. The aim of this study was to delineate the incidence, potential risks, timing of occurrence, clinical features, and outcomes of cardiac rupture complicating AMI after d-PCI. METHODS AND RESULTS Between May 1993 and July 2002, a total of 1,250 patients with AMI underwent d-PCI in our hospital. Of these 1,250 patients studied, 12 patients (0.96%) had cardiac rupture (ventricular septal defect [VSD], three patients; left ventricular [LV] free wall rupture, nine patients] after d-PCI, with a mean (+/- SD) time of occurrence of 52.3 +/- 36.2 h. Three patients with VSD had an insidious presentation, and two of these patients (66.6%) survived after surgical intervention. However, nine patients with LV free wall rupture always presented with sudden and unanticipated hemodynamic collapse. Cardiopulmonary resuscitation was uniformly unsuccessful in patients with LV free wall rupture, and all patients died as a result of this complication within minutes of its onset. The 30-day mortality rate was significantly higher in patients with cardiac rupture than in patients without this complication (83.3% vs 8.2%, respectively; p < 0.001). Univariate analysis demonstrated that the left anterior descending artery was the most likely to be totally occluded in patients who had developed cardiac rupture (100% vs 66.4%, respectively; p = 0.033). Multiple stepwise logistic regression analysis demonstrated that the most significant factors associated with cardiac rupture were advanced age, female gender, and lower body mass index (BMI; all p < 0.05), whereas early reperfusion with d-PCI was an independent determinant of preventing this complication (p < 0.0001). CONCLUSION Compared with the prethrombolytic era, our study showed that d-PCI had a favorable impact on reducing the incidence of cardiac rupture after AMI. Old age, female gender, lower BMI, and longer time to reperfusion carried a substantially increased risk of cardiac rupture after patients experienced AMIs. Early successful d-PCI was the most powerful determinant of the avoidance of this catastrophic complication after AMI.
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Affiliation(s)
- Hon-Kan Yip
- Division of Cardiology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China
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31
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Sugiura T, Nagahama Y, Nakamura S, Kudo Y, Yamasaki F, Iwasaka T. Left ventricular free wall rupture after reperfusion therapy for acute myocardial infarction. Am J Cardiol 2003; 92:282-4. [PMID: 12888132 DOI: 10.1016/s0002-9149(03)00625-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We evaluated the clinical significance of angiographic indexes and pericardial involvement in predicting increased risk of free wall rupture after reperfusion therapy and found that Thrombolysis In Myocardial Infarction (TIMI) <3 flow grade after reperfusion therapy was a significant variable related to the free wall rupture. Moreover, pericardial rub was found to be a significant variable related to TIMI <3 grade flow after reperfusion, which indicates that detection of pericardial rub is one of the clinical signs that predicts inadequate anterograde flow of the infarct-related artery after reperfusion and hence, higher risk for free wall rupture.
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Affiliation(s)
- Tetsuro Sugiura
- Department of Clinical Laboratory Medicine, Kochi Medical School, Kochi, Japan.
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32
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Tanaka K, Sato N, Yasutake M, Takeda S, Takano T, Tanaka S. Clinical course, timing of rupture and relationship with coronary recanalization therapy in 77 patients with ventricular free wall rupture following acute myocardial infarction. J NIPPON MED SCH 2002; 69:481-8. [PMID: 12382012 DOI: 10.1272/jnms.69.481] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study aimed to analyze the clinical course, timing of rupture and relationship with percutaneous coronary intervention (PCI) in patients with cardiac free wall rupture (FWR) following acute myocardial infarction (AMI). FWR was observed in 77 (2.3%) of 3, 284 patients with AMI in our CCU over 28 years. 47 (61.0%) cases were male and mean of age was 69.8 year old. Rupture occurred on Day 1 of infarction in 46 patients (59.7%). 22 cases (28.6%) had cardiogenic shock before FWR. 10 cases (13.0%) had double rupture preceded by ventricular septal perforation (VSP). 25 cases (32.5%) were treated with thrombolytic agents, and only 10 cases (13.0%) had percutaneous coronary intervention (PCI). Before 1981, when PCI was not indicated, incidence of FWR was 2.7%. After 1988 (the era of PCI), the incidence decreased to 1.1%. FWR and the era showed a significant negative correlation (r=0.519: P=0.0056). Rupture was abrupt in 51 cases (66.2%: abrupt type) and was gradual in 26 cases (33.8%: oozing type). The percentages of female, patients with cardiogenic shock before rupture, patients treated by thrombolytic agents and survival rate were significantly higher in the slow-onset rupture group than in the abrupt-onset rupture group. The percentage of patients treated by PCI was extremely low (7.8%) in abrupt-onset group. Of all patients, only 8 (10.4%) survived by emergency operation. One patient with abrupt type survived emergency pericardiotomy in the CCU. One patient with abrupt type and 4 patients with oozing type who had emergency operation in operation room survived. 2 patients with oozing type survived by pericardial drainage and strict blood pressure control. We conclude that early recognition and emergency surgery without thrombolytic therapy may substantially reduce mortality in oozing ruptures. Moreover, immediate and adequate reperfusion by PCI may prevent development of abrupt rupture following acute myocardial infarction.
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Affiliation(s)
- Keiji Tanaka
- Division of Intensive and Coronary Care Unit, Nippon Medical School Hospital, Japan.
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33
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Figueras J, Juncal A, Carballo J, Cortadellas J, Soler JS. Nature and progression of pericardial effusion in patients with a first myocardial infarction: relationship to age and free wall rupture. Am Heart J 2002; 144:251-8. [PMID: 12177642 DOI: 10.1067/mhj.2002.123840] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Left ventricular free wall rupture (FWR) usually develops within the first days of acute myocardial infarction (AMI) without warning, but it is uncertain whether a mild pericardial effusion might herald this complication. METHODS A 2-dimensional echocardiogram (2DE) was performed in patients with first AMI with (1149) or without (324) ST-segment elevation within 2 days. A second 2DE was performed 2 to 4 days later in 300 patients, 100 with and 200 without an initial mild PE (3-9 mm), and in those with initial moderate-severe PE (> or =10 mm) (MSPE) or who developed hypotension or died. RESULTS The first 2DE showed mild PE in 177 patients and MSPE in 51 patients, whereas a late (>2 days) MSPE occurred in 27 with a second routine 2DE, 15 (15%) with and 12 (6%) without initial mild PE (P =.01). Fourteen additional patients, 5 of 77 (6%) with and 9 of 1045 (1%) without initial PE, presented with hypotension and late MSPE (P <.002). Of 92 patients with MSPE, 90 had ST-segment elevation (98%), 60 had tamponade (65%), and 38 died of FWR or were operated on (41%). Results of pericardiocentesis performed in 64 patients were positive in 58, with hemopericardium in 57 (98%). Multivariant analysis showed mild PE on first 2DE and age of >60 years as the only independent predictors of late MSPE or late tamponade. CONCLUSIONS Mild PE within the first 2 days in patients aged >60 years with a first ST-segment elevation AMI is associated with an increased risk of late MSPE. Moreover, in this setting MSPE is most frequently associated with hemopericardium, and two thirds of these patients may develop tamponade/FWR.
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Affiliation(s)
- Jaume Figueras
- Unitat Coronaria, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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34
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Krakau I, Lapp H, Wolfertz J, Gülker H. Direct visualization of left ventricular free wall rupture by levocardiography. Catheter Cardiovasc Interv 2002; 56:238-42. [PMID: 12112922 DOI: 10.1002/ccd.10178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Two cases of left ventricular free wall rupture and one case of combined left ventricular free wall and ventricular septal rupture are described where ventriculography played a key role in diagnosis. In all three cases of patients with acute myocardial infarction, identification and localization of the defect was made by angiography. This report illustrates the safety and feasibility of ventriculography in patients with suspected cardiac rupture.
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Affiliation(s)
- Ingo Krakau
- Department of Cardiology, Wuppertal Heart Center, University of Witten/Herdecke, Germany.
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35
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Wehrens XH, Doevendans PA, Widdershoven JW, Dassen WR, Prenger K, Wellens HJ, Gorgels AP. Usefulness of sinus tachycardia and ST-segment elevation in V(5) to identify impending left ventricular free wall rupture in inferior wall myocardial infarction. Am J Cardiol 2001; 88:414-7. [PMID: 11545766 DOI: 10.1016/s0002-9149(01)01691-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- X H Wehrens
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands
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36
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Figueras J, Cortadellas J, Domingo E, Soler-Soler J. Survival following self-limited left ventricular free wall rupture during myocardial infarction. Management differences between patients with or without pseudoaneurysm formation. Int J Cardiol 2001; 79:103-11; discussion 111-2. [PMID: 11461727 DOI: 10.1016/s0167-5273(01)00415-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The clinical, angiographic and therapeutic features of eight patients who developed a left ventricular pseudoaneurysm (PA) after an acute myocardial infarction (AMI) and those of 25 who did not develop this complication following a medically managed left ventricular free wall rupture (FWR) were compared. These 25 patients were treated with pericardiocentesis, extended rest and strict blood pressure control. Most patients with FWR or PA had a first AMI and absence of overt heart failure. Both groups had a comparable age, frequency of systemic hypertension and extent of coronary disease. Pericardial effusion (> or =10 mm) was documented in all patients with FWR and in two of the three with PA with this information. Twenty four patients with FWR were hospitalized within the first 48 h (96%) but only three of those with PA (37.5%, P<0.002). Moreover, in patients with PA, a FWR was not suspected during AMI and, as opposed to those with FWR, they did not undergo a strict blood pressure control or a restriction of physical activity following AMI. Also, beta blockers were administered to 15 patients with FWR (60%) but to only one with PA (11%, P<0.02). Our findings suggest that failure to recognise a self limited FWR during AMI and to provide adequate control of blood pressure and physical exercise during the acute phase and the early weeks postinfarction, are likely to favor development of PA.
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Affiliation(s)
- J Figueras
- Unitat Coronària, Servei de Cardiologia, Hospital General Vall d'Hebron, Barcelona, Spain.
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37
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Tobar R, Kriwisky M, Rozenman Y, Harpaz D. Acute myocardial infarction caused by coronary embolism complicated by left ventricular free wall rupture. J Am Soc Echocardiogr 2001; 14:754-6. [PMID: 11447426 DOI: 10.1067/mje.2001.110374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Acute myocardial infarction with normal coronary arteries is a relatively infrequent finding. This report describes a rare combination of an embolic event to a normal coronary artery, presumably originating from a left atrial thrombus. An anomalous origin of the infarct-related coronary artery presumably enabled preferential penetration of the clot into the artery. The infarction was further complicated by rupture of the left ventricular free wall.
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Affiliation(s)
- R Tobar
- Heart Institute, E. Wolfson Medical Center, Holon, Sackler School of Medicine, Tel-Aviv University
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38
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Prieto A, Eisenberg J, Thakur RK. NONARRHYTHMIC COMPLICATIONS OF ACUTE MYOCARDIAL INFARCTION. Emerg Med Clin North Am 2001; 19:397-415, xii-xiii. [PMID: 11373986 DOI: 10.1016/s0733-8627(05)70191-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Complications of acute myocardial infarction can be categorized as nonarrhythmic or arrhythmic; the latter is discussed elsewhere. Patients are at risk for a number of potentially serious or fatal complications during or after the acute infarction phase. These include shock, left ventricular free wall rupture, rupture of the interventricular septum, papillary muscle rupture, ventricular pseudoaneurysm, and stroke. Right ventricular infarction, which is typically associated with inferior myocardial infarction, will also be discussed.
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Affiliation(s)
- A Prieto
- Division of Cardiology, Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan, USA
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39
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Harpaz D, Kriwisky M, Cohen AJ, Medalion B, Rozenman Y. Unusual form of cardiac rupture: sealed subacute left ventricular free wall rupture, evolving to intramyocardial dissecting hematoma and to pseudoaneurysm formation--a case report and review of the literature. J Am Soc Echocardiogr 2001; 14:219-27. [PMID: 11241018 DOI: 10.1067/mje.2001.110780] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This report describes an unusual course of rupture of the left ventricular free wall, complicating acute myocardial infarction. Spontaneous sealing of the rupture site enabled close echocardiographic follow-up, during which we monitored the development of intramyocardial dissecting hematoma and, finally, development of a full tear in the left ventricular free wall, leading to the formation of a pseudoaneurysm. The pathophysiology, management, and diagnostic criteria of these processes are being revised.
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Affiliation(s)
- D Harpaz
- Heart Institute and the Department of Cardiovascular Surgery, E. Wolfson Medical Center, Holon; and the Sackler School of Medicine, Tel Aviv University; Israel.
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40
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Park WM, Connery CP, Hochman JS, Tilson MD, Anagnostopoulos CE. Successful repair of myocardial free wall rupture after thrombolytic therapy for acute infarction. Ann Thorac Surg 2000; 70:1345-9. [PMID: 11081896 DOI: 10.1016/s0003-4975(00)01928-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Controversy exists regarding the timing of thrombolytic administration and rupture rate. METHODS Hospital records at St. Luke's-Roosevelt Hospital of the 4 study patients were reviewed and compared with those of 41 patients from a group of 537 patients concurrently admitted with a diagnosis of myocardial infarction (MI). RESULTS Four patients experienced ventricular free wall rupture after having a MI between November 17, 1993, and July 28, 1995. All received tissue plasminogen activator. In 1 patient, pericardial effusion associated with a pseudoaneurysm was discovered in the operating room. The 3 others developed clinical pericardial tamponade before surgery. All 4 patients survived and left the hospital on postoperative days 10, 11, 11, and 82, respectively. During this same time period, 537 patients were admitted with MI, 41 of whom died; the study's 4 patients were compared with these 41. CONCLUSIONS These data demonstrate that rupture of the ventricular free wall can occur early after thrombolytic therapy and may have a subacute course. Prompt diagnosis and surgery offer excellent chances of surviving this fatal condition.
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Affiliation(s)
- W M Park
- Division of Cardiothoracic Surgery, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10025, USA
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41
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Thanigaraj S, Pérez JE. Diagnosis of cardiac rupture with the use of contrast-enhanced echocardiography. J Am Soc Echocardiogr 2000; 13:862-5. [PMID: 10980090 DOI: 10.1067/mje.2000.107005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We describe 3 patients with suspected subacute cardiac rupture in whom contrast-enhanced echocardiography played a key role in the diagnosis. In 2 patients, extravasation of the contrast material into the extracardiac space provided direct evidence of subacute cardiac rupture. Absence of this feature helped to exclude cardiac rupture with active hemorrhage into the pericardial space in the third patient. These 3 cases illustrate the safety and applicability of contrast echocardiography in patients with suspected cardiac rupture.
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Affiliation(s)
- S Thanigaraj
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO 63110, USA
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42
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Figueras J, Cortadellas J, Soler-Soler J. Left ventricular free wall rupture: clinical presentation and management. Heart 2000; 83:499-504. [PMID: 10768896 PMCID: PMC1760810 DOI: 10.1136/heart.83.5.499] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- J Figueras
- Unitat Coronària, Servei de Cardiologia, Hospital General Vall d'Hebron, P Vall d'Hebron 119-129, Barcelona 08035, Spain
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43
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AZRAK ELIE, KERN MORTONJ, GALAMBOS CSABA. Combined Myocardial Free-Wall and Pericardial Rupture with Hemothorax Complicating Acute Myocardial Infarction. J Interv Cardiol 2000. [DOI: 10.1111/j.1540-8183.2000.tb00697.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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44
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Sharma ND, Farha A, Alam M. Cardiogenic shock secondary to myocardial rupture contained by a thrombus with left atrial and pulmonary venous compression. Echocardiography 2000; 17:195-6. [PMID: 10978982 DOI: 10.1111/j.1540-8175.2000.tb01125.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- N D Sharma
- Cardiac Echocardiography, K-14, Cardiology, Henry Ford Heart and Vascular Institute, 2799 W. Grand Boulevard, Detroit, MI 48202, USA
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45
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Okabe M, Fukuda K, Arakawa K. Postmortem evaluation of morphologic changes in the infarcted myocardium that predict ventricular septal rupture in acute anteroseptal infarction. JAPANESE CIRCULATION JOURNAL 1999; 63:485-9. [PMID: 10406590 DOI: 10.1253/jcj.63.485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although thinning of the ventricular wall due to infarct expansion (septal aneurysm) may contribute to ventricular septal rupture (VSR), spatial factors predisposing to this mechanical complication have not been fully demonstrated. To identify the morphologic predictors of VSR, a retrospective postmortem study was performed on 17 hearts with acute anteroseptal myocardial infarction, comprising 7 with VSR and 10 without rupture. Infarct size and the extent of wall thinning were quantified. Wall thinning was defined as a decrease of less than 50% of thickness of the noninfarcted wall. The total infarct size did not differ among the groups. In the free wall (FW), the infarct was smaller in hearts with VSR than in those with a ruptured FW (p<0.05) or no rupture (p<0.01). The septal involvement was more extensive in patients with VSR than in those with FW rupture (p<0.05). Septal thinning was more extensive in hearts with VSR than in those with FW rupture (p<0.05) or non-rupture (p<0.05). A combination of a small infarct of the FW and a large septal infarct may contribute to the formation of septal aneurysm, which is believed to predispose to VSR. The presence of a small infarct of the anterior septum may be another setting for postinfarction septal rupture.
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Affiliation(s)
- M Okabe
- Department of Internal Medicine, School of Medicine, Fukuoka University, Japan
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46
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Abstract
CHD in the elderly population will continue to be a source of major concern because of the increasing costs entailed and uncertainties about how the widespread array of diagnostic and therapeutic interventions, often expensive and sometimes hazardous, should be applied. Financial, political, and health policy decisions will continue to occupy much attention, but it is likely that philosophic considerations about aging and death, both from the individual and the societal perspective, will be of paramount importance of deciding how the substantial resources available to the elderly will be used. Randomized, controlled trials are unlikely to play a major role in resolution of management dilemmas in the elderly because of the extraordinary heterogeneity in this population. Registries (databases) involving carefully prospectively collected key variables are likely to be a more effective approach. Critical characterization of complications of procedures, adverse drug reactions, and collection of follow-up data on functional status are among the critical questions, and these can be answered by registry studies. Algorithms and clinical rules developed in younger cohorts are not directly transferable to the elderly cardiovascular patients, further emphasizing the need for prospectively collected, syndrome-specific data. Treatments convincingly demonstrated to reduce mortality in absolute terms more in the elderly than in the young are underused. The heterogeneity of aging emphasizes the wide variability in patients' ability to withstand the stress of procedures and complications of disease and makes clear the need to consider physiologic reserve and biologic age rather than chronology. With better characterization of biologic age and physiologic reserve, more precise estimates of outcomes of therapies and interventions can be made, and patients can be given better information and with their families have more realistic expectations. Better-informed decisions will result. Biologic age will be multifactorial, involving cognitive, emotional, physical, and nutritional attributes as well as specific organ function (lung, kidney, liver) because no single feature can characterize the total elderly patient. The concept of competing risks among the cardiovascular disease being treated, comorbidity, risks of study, and life expectancy will evolve because even the most successful therapy will have limited effect on longevity in the very old. Although important research at the cellular and molecular level will characterize and provide better understanding of the aging process, it is not likely that this basic information will be immediately useful in the management of the large number of elderly patients with major cardiovascular disease. Preventive measures, including physical exercise, mental stimulation, avoidance of depression, good nutrition, and abstinence from tobacco use, are useful approaches to postpone or ameliorate the consequences of aging and allow patients to tolerate cardiovascular diseases better when they become manifest.
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Affiliation(s)
- G C Friesinger
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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47
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Csapo K, Voith L, Szuk T, Edes I, Kereiakes DJ. Postinfarction left ventricular pseudoaneurysm. Clin Cardiol 1997; 20:898-903. [PMID: 9377830 PMCID: PMC6655895 DOI: 10.1002/clc.4960201021] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/1997] [Accepted: 06/18/1997] [Indexed: 02/05/2023] Open
Abstract
Left ventricular wall rupture after myocardial infarction is a mechanical complication that may result in a pseudoaneurysm. Between January 1994 and October 1996, false or pseudoaneurysms were detected in 6 (0.0026%) of 2,600 consecutive patients (4 women, 2 men; mean age 59.4 years) undergoing cardiac catheterization at University Medical School, Debrecen, Hungary. All patients had a history of cardiovascular disease, with diagnosis of pseudoaneurysm confirmed by echocardiography. The average time from the occurrence of acute infarction to diagnosis was 37.0 days (range 3-80 days). All patients were in New York Heart Association functional class IV congestive heart failure; in four patients cardiogenic shock was present. Five patients underwent coronary angiography, which demonstrated multivessel disease and occlusion of the infarct-related artery (TIMIO) without adequate collateral circulation (grade 0-1). Five patients had surgical repair of the false aneurysm, and, in three patients, concomitant coronary bypass grafting was performed. The 2-year mortality rate for all patients was 50%. Early diagnosis of false aneurysm is facilitated by echocardiography, and coronary angiography is required before surgery. Early surgical correction with coronary revascularization is advised.
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Affiliation(s)
- K Csapo
- Department of Heart and Lung Diseases, University Medical School, Debrecen, Hungary
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48
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Abstract
Several clinical factors can influence the pathophysiology, clinical course and prognosis of acute myocardial by different means. Some of them may be easily detected through the history, physical examination or ECG in an early phase. The knowledge of these factors may help the therapeutic decision making of patients with myocardial infarction. The influence for the main clinical factors (age, sex, risk factors, cardiologic antecedents and evolutive findings) on the short-term prognosis of acute myocardial infarction is reviewed. An analysis of the likely mechanisms of the influence of these factors on infarct prognosis is also performed.
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Affiliation(s)
- H Bueno
- Departamento de Cardiología, Hospital Universitario General Gregorio Marañón, Madrid
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49
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Purcaro A, Costantini C, Ciampani N, Mazzanti M, Silenzi C, Gili A, Belardinelli R, Astolfi D. Diagnostic criteria and management of subacute ventricular free wall rupture complicating acute myocardial infarction. Am J Cardiol 1997; 80:397-405. [PMID: 9285648 DOI: 10.1016/s0002-9149(97)00385-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In this prospective study we evaluated the value of the main diagnostic criteria for postinfarction subacute rupture of the ventricular free wall. Two-dimensional echocardiograms and recordings of right atrial pressure and waveform were immediately obtained in every patient exhibiting rapid clinical and/or hemodynamic compromise in the acute infarction setting. The same protocol was applied to patients referred from other hospitals for suspected myocardial rupture. In 28 cases a subacute free wall rupture was identified. In most of the patients the diagnosis was based on the demonstration of hemopericardium and cardiac tamponade by echocardiography, cardiac catheterization and, occasionally, by pericardiocentesis. In 2 instances, the identification of intrapericardial echo densities suggesting clots, in the absence of cardiac tamponade, allowed a diagnosis of subacute rupture. Direct, but indistinct visualization of myocardial rupture was obtained in 4 cases. Among the 28 patients with this complication, 4 died while awaiting surgery and 24 underwent surgical repair (mortality rate 33%). Long-term outcome of survivors was favorable. Various myocardial lesions underlie postinfarction subacute free wall rupture. Clinical presentation varied widely. The diagnosis was based, usually but not always, on the association of hemopericardium and signs of cardiac tamponade. An organized approach to management of this complication of acute myocardial infarction was suggested.
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Affiliation(s)
- A Purcaro
- Division of Cardiology, Ospedale cardiologico G.M. Lancisi, Ancona, Italy
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Anzai T, Yoshikawa T, Shiraki H, Asakura Y, Akaishi M, Mitamura H, Ogawa S. C-reactive protein as a predictor of infarct expansion and cardiac rupture after a first Q-wave acute myocardial infarction. Circulation 1997; 96:778-84. [PMID: 9264482 DOI: 10.1161/01.cir.96.3.778] [Citation(s) in RCA: 202] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pump failure after acute myocardial infarction (AMI) can be predicted by several indices that estimate infarct size. However, there are few indices that predict infarct expansion and cardiac rupture. We focused on the prognostic significance of serum C-reactive protein (CRP) after AMI. METHODS AND RESULTS Serum CRP levels were measured every 24 hours in 220 patients with a first Q-wave AMI. In-hospital complications, predischarge left ventriculographic findings, and long-term prognosis were assessed in relation to peak CRP levels. Peak levels of both CRP and creatine kinase (CK) were higher in patients with pump failure than in those without pump failure. In patients with cardiac rupture, peak CRP levels were higher than in those without rupture (P=.001); peak CK levels were not predictive. Higher CRP levels were found in patients with left ventricular aneurysm (P=.001 versus those without), aggravated heart failure (P=.03 versus those without), and cardiac death (P<.0001 versus survivors) during the first year after AMI. Multivariate analysis confirmed that an elevation of the peak CRP level > or = 20 mg/dL was an independent predictor of cardiac rupture (relative risk, 4.72; P=.004), left ventricular aneurysmal formation (relative risk, 2.11; P=.03), and 1-year cardiac death (relative risk, 3.44; P<.0001). CONCLUSIONS Cardiac rupture, left ventricular aneurysmal formation, and 1-year cardiac death were associated with an elevation of serum CRP early after AMI, suggesting that elevation of CRP levels after AMI may predict infarct expansion.
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Affiliation(s)
- T Anzai
- Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
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