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Myocardial Rupture Differential Diagnoses

  • Author: Jamshid Shirani, MD; Chief Editor: Eric H Yang, MD  more...
 
Updated: Nov 10, 2014
 
 

Diagnostic Considerations

Physicians should have a high index of suspicion for myocardial rupture after acute myocardial infarction (AMI). Especially during the first week, it is critical to make the diagnosis and perform emergency life-saving interventions as expeditiously as possible. Failure to diagnose or act quickly could expose physicians to legal liability.

The possibility of cardiac injury should be considered in all patients with high-velocity deceleration blunt injuries. Failure to diagnose myocardial rupture or early discharge of stable patients from the emergency department could result in serious legal consequences.

In addition to the conditions listed in the differential diagnosis, other problems to be considered include true ventricular aneurysm and cardiac contusion.

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Jamshid Shirani, MD Director of Cardiology Fellowship Program, Director of Echocardiography Laboratory, Director of Hypertrophic Cardiomyopathy Clinic, St Luke's University Health Network

Jamshid Shirani, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society of Echocardiography, Association of Subspecialty Professors, American College of Cardiology, American College of Physicians, American Heart Association

Disclosure: Nothing to disclose.

Coauthor(s)

Jamshid Alaeddini, MD, FACC, FHRS Director, Cardiac Electrophysiology Services, Lake Health System

Jamshid Alaeddini, MD, FACC, FHRS is a member of the following medical societies: American College of Cardiology, American Heart Association, Heart Rhythm Society

Disclosure: Nothing to disclose.

Alessandra Brofferio, MD Staff Cardiologist, Cardiology Branch, National Heart, Lung, and Blood Institutes, National Institutes of Health, Bethesda, MD

Disclosure: Nothing to disclose.

Chief Editor

Eric H Yang, MD Associate Professor of Medicine, Director of Cardiac Catherization Laboratory and Interventional Cardiology, Mayo Clinic Arizona

Eric H Yang, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Acknowledgements

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric Vanderbush, MD, FACC Chief, Department of Internal Medicine, Division of Cardiology, Harlem Hospital Center; Clinical Assistant Professor of Cardiology, Columbia University College of Physicians and Surgeons

Eric Vanderbush, MD, FACC is a member of the following medical societies: American College of Cardiology and American Heart Association

Disclosure: Nothing to disclose.

References
  1. Helmy TA, Nicholson WJ, Lick S, Uretsky BF. Contained myocardial rupture: a variant linking complete and incomplete rupture. Heart. 2005 Feb. 91(2):e13. [Medline].

  2. 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 Jun. 18(3):167-72. [Medline].

  3. Kumar S, Kaushik S, Nautiyal A, et al. Cardiac rupture in takotsubo cardiomyopathy: a systematic review. Clin Cardiol. 2011 Nov. 34(11):672-6. [Medline].

  4. Dumont E, Rodés-Cabau J, De LaRochellière R, Lemieux J, Villeneuve J, Doyle D. Rapid pacing technique for preventing ventricular tears during transapical aortic valve replacement. J Card Surg. 2009 May-Jun. 24(3):295-8. [Medline].

  5. Javaid MM, Grigoriou A, Katsianos D, Kon SP. Nephrotic and anti-phospholipid syndromes: Multisystem conditions associated with acute myocardial infarction in young patients. J Ren Care. 2011 Sep 14. [Medline].

  6. Honda S, Asaumi Y, Yamane T, et al. Trends in the clinical and pathological characteristics of cardiac rupture in patients with acute myocardial infarction over 35 years. J Am Heart Assoc. 2014 Oct 20. 3(5):e000984. [Medline].

  7. Suzuki M, Enomoto D, Seike F, Fujita S, Honda K. Clinical Features of Early Myocardial Rupture of Acute Myocardial Infarction. Angiology. 2011 Nov 8. [Medline].

  8. Hayashi T, Hirano Y, Takai H, et al. Usefulness of ST-segment elevation in the inferior leads in predicting ventricular septal rupture in patients with anterior wall acute myocardial infarction. Am J Cardiol. 2005 Oct 15. 96(8):1037-41. [Medline].

  9. Mehta RH, Grab JD, O'Brien SM, et al. Clinical characteristics and in-hospital outcomes of patients with cardiogenic shock undergoing coronary artery bypass surgery: insights from the Society of Thoracic Surgeons National Cardiac Database. Circulation. 2008 Feb 19. 117(7):876-85. [Medline].

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Photograph of heart of 43-year-old man demonstrating site of stab wound over left ventricular lateral free wall (shown as vertical tear).
Photograph of heart sectioned transversely at level of middle left ventricle showing posterior ventricular septal defect at site of recent acute myocardial infarction.
Photograph of mitral valve and subvalvular apparatus showing site of ischemic papillary muscle (PM) rupture (R).
Magnified photograph of transverse section of middle left ventricle (LV) showing transmural lateral free-wall rupture (R).
Chest radiograph in posteroanterior projection showing large pseudoaneurysm manifesting as bulge in left cardiac border.
 
 
 
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