II. Electrocardiographic changes

Subacute rupture of the free left ventricular wall following acute myocardial infarction. Report of an atypical case with successful surgical repair

In previously published cases of subacute or sealed postinfarction rupture of the free left ventricular wall, the patients presented a clinical picture of sudden shock and tamponade. Our patient, a 64-year-old man, suffered renewed chest pain on the fourth postinfarction day and went into cardiogenic shock, which was pharmacologically reversible. There were no bed-side signs of tamponade and the ECG showed the pattern of acute pericarditis, both features in contrast to previously reported cases in the literature. Echocardiography demonstrated localized fluid in the pericardial sac and a puncture revealed non-coagulating blood. The patient was successfully operated on. At surgery a small rupture sealed by blood clots was demonstrated in the infarcted inferior wall of the left ventricle.

Subacute cardiac rupture: repair with a sutureless technique

Thirteen patients with ages between 53 and 74 years had development of free wall left ventricular rupture after a myocardial infarction (mean interval, 3.8 days). All patients showed clinical signs of cardiac tamponade. Diagnosis was established by bedside multiple pressure monitoring and echocardiography, which showed pericardial effusion with compression of the right ventricle. Cardiac catheterization was not performed. A new surgical technique was employed for the repair. After the pericardium was opened and cardiac tamponade was relieved, the myocardial tear was identified. A Teflon patch was applied over the area and glued to the heart surface with a surgical glue (cyanoacrylate). Cardiopulmonary bypass was not used except in a patient with a posterior tear. The method was consistently effective in controlling bleeding from the myocardial tear. All patients survived the operation and were discharged from the hospital a mean of 15 days after the operation. Follow-up extending up to 5 years (mean, 26 months) shows a 100% survival, 11 asymptomatic patients, and 2 patients with mild exertional angina. The technique is a simple, effective, and safe method for repair of subacute cardiac rupture and obviates the need for suturing on an infarcted ventricle.

Surgical salvage of heart rupture: report of two cases and review of the literature

Two patients who sustained cardiac rupture complicating recent myocardial infarction were salvaged by expeditious diagnosis and surgical treatment. The cases of 9 other similar patients have been reported in the English-language literature. The cases of these 11 patients were reviewed in an attempt to find common clinical, pathological, and therapeutic features that might have been instrumental in the successful outcome of this usually fatal complication.

Survival after subacute cardiac rupture

A 43-year-old man collapsed suddenly, with pericardial tamponade, seven weeks after an inferior myocardial infarction. Pericardiocentesis disclosed very heavily blood stained fluid. Left ventricular angiography 10 days later showed a left ventricular aneurysm. At operation a left ventricular false aneurysm was resected and the patient recovered uneventfully.

Acute myocardial infarction in hospitalized patients over age 70

The history and clinical course of 175 patients aged 70 and older (Group A) with acute myocardial infarction (MI) was studied to determine the hospital mortality rate in this population group and to determine the clinical factors that influenced the hospital mortality rate. The mortality rate of a second group of 772 patients below age 70 years (Group B) admitted during the same time period was determined for comparison with the mortality rate of Group A. The hospital mortality rate in Group A (32%) was 3.9 times the hospital mortality rate in Group B (8.2%). Advanced age was associated with a significantly higher mortality rate, even when so called "good risk" patients from Group A were compared with patients in Group B. The major causes of death in this hospitalized group of patients aged 70 and older were shock (33.9%) and cardiac rupture (28.6%). Factors that significantly influenced hospital mortality rate in the elderly group were the development of shock, pulmonary edema on chest x-ray, a clinical diagnosis of congestive heart failure, and the development of complete heart block or new bundle branch block during the hospital course.

Postinfarction cardiac rupture: surgical success and review of the literature

Cardiac rupture following myocardial infarction has been reported as the cause of 4 to 24% of all infarction deaths. The rupture may occur from a few hours to several days after the myocardial infarction and is not a true "blowout" but rather a necrotic hemorrhagic area in the center of the infarction that extravasates blood and leads to pericardial tamponade. The most common findings when rupture occurs are renewed chest pain, bradycardia, and shock. Two patients with postinfarction myocardial rupture who were operated on successfully are reported. With prompt diagnosis and treatment, more of these patients would survive long enough to undergo operation. With cardiopulmonary bypass the repair of these ruptures is not difficult.

Cardiac rupture complicating acute myocardial infarction in presence of normal electrocardiogram

Cardiac rupture following acute myocardial infarction occurs most frequently in patients with electrocardiographic evidence of transmural infarction. Unusual presentations of cardiac rupture need immediate recognition to enable successful surgical treatment. An unusual case is presented of cardiac rupture complicating acute myocardial infarction despite a normal electrocardiogram prior to the rupture.