Cardiac rupture occurred in ~2.4 % of AMI patients and accounted for ~ 17.6 % of total deaths from AMI .( a Italian study 95` apr with study of ~ 5000 AMI patients )

Cardiac rupture occurred after transmural myocardial necrosis , ususally (60%) following an anterior AMI. It is an early phenomenon ( in 40% it occurred within the first 24 hours and in more than 80% within 5 days from symptoms onset )

Patients at risk of cardiac rupture including

· female sex

· elderly

· history of hypertension

· AMI as the first presentation of IHD

· pericarditis

· repetitive emesis ,restlessness and agitation

· a deviation from the expected evolutionary T wave pattern

· an abrupt transient episode of hypotension and bradycardia

Patients displaying these symptoms , signs and ECG changes required a bedside echocardiogram and echocardiographically guided pericardiocentesis if fluid is visualized . If the pericardiocentesis identifies the fluid as blood , immediate surgery is indicated .

Thrombolytic therapy :

Thrombolytic therapy early after acute myocardial infarction improves survival and decreases the risk of cardiac rupture . Late administration of thrombolytic therapy also appears to improve survival but may increase the risk of cardiac rupture .( data analysis from the GISSI trial )

GISSI -2 study : IV atenolol in the acute phase of AMI can decrease mortality through a decrease incidence of malignant arrhythmia and cardiac rupture .

Back to Cardiology Home Page