It can also be caused by trauma. Sudden death caused by a myocardial rupture is sometimes preceded by no symptoms. The most common cause of myocardial rupture is a recent myocardial infarction, with the rupture typically occurring three to five days after infarction. Other presenting signs types of myocardial infarction pdf with myocardial rupture include a pericardial friction rub, sluggish flow in the coronary artery after it is opened i.
Due to the acute hemodynamic deterioration associated with myocardial rupture, the diagnosis is generally made based on physical examination, changes in the vital signs, and clinical suspicion. The diagnosis is ultimately made at autopsy. Myocardial ruptures can be classified as one of three types. Type I myocardial rupture is an abrupt slit-like tear that generally occurs within 24 hours of an acute myocardial infarction. Type II is an erosion of the infarcted myocardium, which is suggestive of a slow tear of the dead myocardium.
Type II ruptures typically occur more than 24 hours after the infarction occurred. Type III ruptures are characterized by early aneurysm formation and subsequent rupture of the aneurysm. Another method for classifying myocardial ruptures is by the anatomical portion of the heart that has ruptured. Further, the rupture will occur in an area of greatest shear stress. The treatment for myocardial rupture is supportive in the immediate setting and surgical correction of the rupture, if feasible. A certain small percentage of individuals do not seek medical attention in the acute setting and survive to see the physician days or weeks later.
The prognosis of myocardial rupture is dependent on a number of factors, including which portion of the myocardium is involved in the rupture. The chances of survival rise dramatically if the patient: 1. The incidence of myocardial rupture has decreased in the era of urgent revascularization and aggressive pharmacological therapy for the treatment of an acute myocardial infarction. The incidence of myocardial rupture if PCI is performed in the setting of an acute myocardial infarction is about 1 percent. Nan YY, Lu MS, Liu KS, et al. Figueras J, Alcalde O, Barrabes JA, Serra V, Alguersuari J, Cortadellas J, et al.
Changes in Hospital Mortality Rates in 425 Patients with Acute ST-Elevation Myocardial Infarction and Cardiac Rupure Over a 30-Year Period. Association between hypertension and primary mitral chordae tendinae rupture”. Primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction”. Left ventricular free wall rupture after reperfusion therapy for acute myocardial infarction”. A study of 50 hearts”.