Myocardial Rupture Follow-up

  • Author: Jamshid Shirani, MD; Chief Editor: Eric H Yang, MD   more...
 
Updated: Dec 2, 2011
 

Further Inpatient Care

All patients with cardiac rupture should be transferred to the operating room immediately and admitted to the medical ICU or surgical ICU after surgery.

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Transfer

Transfer should be considered only for patients who are in a center without a cardiothoracic surgery unit. The outcome in this setting is quite poor.

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Deterrence/Prevention

Coronary risk factor modification decreases risk of AMI. Avoid NSAIDs or corticosteroids in the early phase of AMI.

Control hypertension and use beta-blockers early in patients with AMI.

Early successful percutaneous coronary intervention (balloon angioplasty and placement of stent) reduces the risk of myocardial rupture following AMI.

Using seat belts can significantly reduce the rate of blunt thoracic trauma resulting from high-speed accidents.

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Complications

Complications include the following:

  • Tamponade
  • Hemothorax
  • Sudden death
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Prognosis

Prognosis depends on the type, size, hemodynamic effects, and cause of myocardial rupture.

Making a quick diagnosis and initiating surgical intervention is crucial. Approximately 50% of patients with cardiac rupture following AMI die within 5 days, and 82% die within 2 weeks of the index infarction. Aggressive early diagnosis and surgery may confer a survival rate as high as 75%.

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Contributor Information and Disclosures
Author

Jamshid Shirani, MD  Director of Cardiology Fellowship Program, Director of Echocardiography Laboratory, St Luke's Hospital and Health Network

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

Disclosure: Nothing to disclose.

Coauthor(s)

Jamshid Alaeddini, MD, FACC  Clinical Cardiac Electrophysiologist, Inland Cardiology Associates

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

Disclosure: Boston Scientific Honoraria Speaking and teaching; Medtronic Honoraria Speaking and teaching; St. Jude Honoraria Speaking and teaching; Reliant Honoraria Speaking and teaching

Alessandra Brofferio, MD  Fellow, Department of Cardiovascular Medicine, Geisinger Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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

Marschall S Runge, MD, PhD  Charles and Anne Sanders Distinguished Professor of Medicine, Chairman, Department of Medicine, Vice Dean for Clinical Affairs, University of North Carolina at Chapel Hill School of Medicine

Marschall S Runge, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Federation for Medical Research, American Heart Association, American Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Association of Professors of Cardiology, Association of Professors of Medicine, Southern Society for Clinical Investigation, and Texas Medical Association

Disclosure: Pfizer Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Orthoclinica Diagnostica Consulting fee Consulting

Amer Suleman, MD  Private Practice

Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Eric H Yang, MD  Associate Professor of Medicine, Director of Interventional Cardiology Fellowship Program, Henry Ford Hospital

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

Disclosure: Nothing to disclose.

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