Diagnostic Considerations
Physicians should have a high index of suspicion for myocardial rupture after acute myocardial infarction (AMI). Myocardial wall rupture should also be a consideration in the setting of hypotension and ST-elevation MI, particularly with delayed onset. [7, 11]
It is especially critical during the first week 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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Myocardial Rupture. Photograph of the heart of 43-year-old man demonstrating the site of a stab wound over the left ventricular lateral free wall (shown as a vertical tear).
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Myocardial Rupture. Photograph of a heart sectioned transversely at the level of the middle left ventricle, showing a posterior ventricular septal defect at the site of a recent acute myocardial infarction.
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Myocardial Rupture. Photograph of a mitral valve and subvalvular apparatus, revealing the site of an ischemic papillary muscle (PM) rupture (R).
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Myocardial Rupture. This magnified photograph of the transverse section of a middle left ventricle (LV) shows a transmural lateral free-wall rupture (R).
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Myocardial Rupture. Chest radiograph in the posteroanterior projection showing a large pseudoaneurysm manifesting as a bulge in the left cardiac border.
