In four patients with rupture of the free wall of the left ventricle, the diagnosis was made at the bedside using a portable cross-sectional echocardiograph; this was confirmed at necropsy in two patients and by paracentesis in the other two. Weak ventricular contractions were seen after each QRS complex of the electrocardiogram, contradicting a widespread belief that cardiac rupture immediately produces electromechanical dissociation. In one patient aspiration of 100 ml blood from the pericardium allowed resumption of cardiac pump function; this patient survived for three days but was allowed to die because of cerebral damage sustained during resuscitation.
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