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In patients with acute myocardial infarction, left ventricular free wall rupture is an infrequent complication (2–4%) but it is associated with a high mortality from pericardial tamponade.1-8 It accounts for 5–24% of all in hospital deaths related to acute myocardial infarction.4 6 9 10 To reduce this high mortality it is important to improve the way in which these patients are classified, as this may help clinicians anticipate myocardial rupture, prevent it occurring, and achieve better therapeutic results when it does occur. In this paper, we provide an update on the clinical, electrocardiographic, echocardiographic, and angiographic features of these patients, identifying the different forms in which free wall rupture presents. We also review the management of these cases and suggest a conservative strategy that may be applied successfully to a selected subgroup of patients.
Clinical profile of patients with free wall rupture
The clinical characteristics of patients with free wall rupture are summarised in table 1. Characteristically, free wall rupture occurs in relatively elderly patients, generally older than 55 years and usually between 65 and 70,1 3-5 11-13 without any apparent sex bias3 14-17—although it may be relatively more common in female patients in view of the lower incidence of acute myocardial infarction in women.4 5 In most cases the myocardial infarct is the first one recorded and it is usually transmural2 4 12-14 18 but without overt heart failure.2 13 14 18 There is an infrequent history of angina pectoris.2 13 14 19 The incidence of diabetes is not particularly high, though arterial hypertension is common—often more than 50%, but with some exceptions.1 5 6 12 14 18 These patients present with a rather prolonged episode of anginal pain, often lasting for four to six hours or more,1 2 4 5 15 16 20 21 …
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