Chest

Chest

Volume 92, Issue 2, August 1987, Pages 219-223
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Cardiac Rupture in Patients with Acute Myocardial Infarction

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The occurrence of myocardial rupture was evaluated in an unselected population of 1,737 patients with acute myocardial infarction (AMI). Patients with cardiac rupture after AMI were compared with age- and sex-matched control patients with fatal AMI not related to rupture and with AMI survivors discharged home. Rupture was found in 40 patients (15.7 percent of hospital deaths), or 2.3 percent of all cases of AMI. At the highest risk for rupture were women aged 60 to 69, although the age distribution did not differ significantly from that of patients dying of other causes. More patients with myocardial rupture had hypertension during hospitalization, persistent pain, and inferior wall myocardial infarction when compared with controls. The majority (95 percent) of cardiac ruptures occurred within the first six days, 40 percent within the first 24 hours after the onset of symptoms. Approximately 20 percent of ruptures were diagnosed as subacute; in only two was surgical intervention attempted unsuccessfully. The high-risk group of patients should be carefully monitored within the first six days after the onset of symptoms of AMI in an effort to prevent myocardial rupture.

Section snippets

MATERIALS AND METHODS

This study reviews the files of a series of consecutive patients with symptoms occurring within 24 hours and diagnosed as having AMI who were admitted to the ICCU of a regional hospital. All patients with suspected AMI are hospitalized in this ICCU without any preselection. The patients remain in the ICCU until they improve and are then discharged home or sent to departments of internal medicine for further care. It is the policy of the ICCU to mobilize the patients with AMI 24 hours after the

Patient Population

During the study period, a total of 1,737 patients were diagnosed as having AMI (56.9 percent of all admissions); 1,279 were men. The age distribution was as follows: 41 percent were less than 59 years old, 32.9 percent between the ages of 60 and 69, and 26 percent of 70 years or more. The age and sex distributions are shown in detail in Table 1.

Mortality

Of patients with AMI, 255 died during the study period (overall mortality, 14.7 percent). The causes of death were: low cardiac output (65.4 percent),

DISCUSSION

The incidence of cardiac rupture in patients with AMI ranges from 1.5 to 8 percent in both general medical wards and ICCU.7, 11, 13, 14, 15, 16 Whereas, in the general medical ward cardiac rupture is responsible for 5 to 12 percent of AMI fatalities,1, 8 the proportion of deaths in the ICCU from this cause is higher (7.9 to 23.5 percent),15, 16 apparently because of lower overall mortality and unchanged number of cases with myocardial rupture,11 which is almost invariably fatal. These data are

REFERENCES (27)

  • JF Maher et al.

    Rupture of the heart after myocardial infarction

    N Engl J Med

    (1956)
  • MP Feneley et al.

    Myocardial rupture after acute myocardial infarction: ten year review

    Br Heart J

    (1983)
  • M Dellborg et al.

    Rupture of the myocardium: occurrence and risk factors

    Br Heart J

    (1985)

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    Manuscript received November 24; revision accepted January 12.

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    Copyright © 1987 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.