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