Myocardial rupture overview: Difference between revisions
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{{Myocardial rupture}} | {{Myocardial rupture}} | ||
{{CMG}}; {{AOEIC}} {{CZ}} | {{CMG}}; {{AOEIC}} {{CZ}} | ||
==Overview== | ==Overview== | ||
Myocardial rupture is a laceration or tearing of the walls of the [[Ventricle (heart)|ventricle]]s or [[atria]] of the [[heart]], of the [[interatrial septum|interatrial]] or [[interventricular septum]], of the [[papillary muscle]]s or [[chordae tendineae]] or of one of the [[heart valve|valves of the heart]]. It is most commonly seen as a serious sequelae of an acute [[myocardial infarction]] (heart attack). | |||
==Pathophysiology== | |||
The most common cause of myocardial rupture is a recent myocardial infarction, with the rupture typically occurring three to five days after infarction. Other causes of rupture include cardiac trauma, [[endocarditis]] (infection of the heart),<ref name="Lin-2006">{{cite journal | author=Lin TH, Su HM, Voon WC, Lai HM, Yen HW, Lai WT, Sheu SH. | title=Association between hypertension and primary mitral chordae tendinae rupture. | journal=Am J Hypertens | year=2006 | volume=19 | issue=1 | pages=75-9 | id=PMID 16461195}}</ref><ref name="de Diego-2006">{{cite journal | author=de Diego C, Marcos-Alberca P, Pai RK. | title=Giant periprosthetic vegetation associated with pseudoaneurysmal-like rupture. | journal=Eur Heart J | year=2006 | volume=27 | issue=8 | pages=912 | format=PDF | url=http://eurheartj.oxfordjournals.org/cgi/reprint/27/8/912.pdf | id=PMID 16569654}}</ref> [[cardiac tumor]]s, infiltrative diseases of the heart,<ref name="Lin-2006"/> and [[aortic dissection]]. | |||
==Epidemiology and Demographics== | |||
The incidence of myocardial rupture has decreased in the era of urgent revascularization and aggressive pharmacological therapy for the treatment of an acute myocardial rupture. However, the decrease in the incidence of myocardial rupture is not uniform; there is a slight increase in the incidence of rupture if thrombolytic agents are used to abort a myocardial infarction.<ref name="Becker-1996">{{cite journal | author=Becker RC, Gore JM, Lambrew C, Weaver WD, Rubison RM, French WJ, Tiefenbrunn AJ, Bowlby LJ, Rogers WJ. | title=A composite view of cardiac rupture in the United States National Registry of Myocardial Infarction. | journal=J Am Coll Cardiol | year=1996 | volume=27 | issue=6 | pages=1321-6 | id=PMID 8626938}}</ref> On the other hand, if [[percutaneous coronary intervention|primary percutaneous coronary intervention]] is performed to abort the infarction, the incidence of rupture is significantly lowered.<ref name="Moreno-2002">{{cite journal | author=Moreno R, Lopez-Sendon J, Garcia E, Perez de Isla L, Lopez de Sa E, Ortega A, Moreno M, Rubio R, Soriano J, Abeytua M, Garcia-Fernandez MA. | title=Primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction. | journal=J Am Coll Cardiol | year=2002 | volume=39 | issue=4 | pages=598-603 | id=PMID 11849857}}</ref> The incidence of myocardial rupture if PCI is performed in the setting of an acute myocardial infarction is about 1 percent.<ref name="Yip-2003">{{cite journal | author=Yip HK, Wu CJ, Chang HW, Wang CP, Cheng CI, Chua S, Chen MC. | title=Cardiac rupture complicating acute myocardial infarction in the direct percutaneous coronary intervention reperfusion era. | journal=Chest | year=2003 | volume=124 | issue=2 | pages=565-71 | format=PDF | url=http://www.chestjournal.org/cgi/reprint/124/2/565.pdf | id=PMID 12907544}}</ref> | |||
==Risk Factors== | |||
Risk factors for rupture after an acute myocardial infarction include female gender, advanced age of the individual, and a low [[body mass index]]. Other presenting signs associated with myocardial rupture include a pericardial friction rub, sluggish flow in the coronary artery after it is opened, the [[left anterior descending artery]] being the cause of the acute MI,<ref name="Sugiura-2003">{{cite journal | author=Sugiura T, Nagahama Y, Nakamura S, Kudo Y, Yamasaki F, Iwasaka T. | title=Left ventricular free wall rupture after reperfusion therapy for acute myocardial infarction. | journal=Am J Cardiol | year=2003 | volume=92 | issue=3 | pages=282-4 | id=PMID 12888132}}</ref> and delay of revascularization greater than 2 hours. | |||
==Natural History, Complications and Prognosis== | |||
The prognosis of myocardial rupture is dependant on a number of factors, including which portion of the myocardium is involved in the rupture. In one case series, if myocardial rupture involved the free wall of the [[left ventricle]], the mortality rate was 100 percent.<ref name="pmid12907544">{{cite journal |author=Yip HK, Wu CJ, Chang HW, Wang CP, Cheng CI, Chua S, Chen MC |title=Cardiac rupture complicating acute myocardial infarction in the direct percutaneous coronary intervention reperfusion era |journal=[[Chest]] |volume=124 |issue=2 |pages=565–71 |year=2003 |month=August |pmid=12907544 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=12907544 |accessdate=2012-04-08}}</ref> Even if the individual survives the initial hemodynamic sequelae of the rupture, the 30 day mortality is still significantly higher than if rupture did not occur.<ref name="pmid12907544">{{cite journal |author=Yip HK, Wu CJ, Chang HW, Wang CP, Cheng CI, Chua S, Chen MC |title=Cardiac rupture complicating acute myocardial infarction in the direct percutaneous coronary intervention reperfusion era |journal=[[Chest]] |volume=124 |issue=2 |pages=565–71 |year=2003 |month=August |pmid=12907544 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=12907544 |accessdate=2012-04-08}}</ref> | |||
== Diagnosis == | |||
=== History and Symptoms === | |||
Symptoms of myocardial rupture are recurrent or persistent [[chest pain]], [[syncope]], and distension of [[jugular vein]]s. 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 can be confirmed with [[echocardiography]]. | |||
=== Physical Examination === | |||
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. | |||
=== Echocardiography === | |||
The diagnosis can be confirmed with [[echocardiography]]. | |||
== Treatment == | |||
=== Medical Therapy === | |||
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 survive. In this setting, it may be reasonable to treat the rupture medically and delay or avoid surgery completely, depending on the individual's [[comorbidity|comorbid]] medical issues. | |||
===Surgery=== | |||
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 survive. In this setting, it may be reasonable to treat the rupture medically and delay or avoid surgery completely, depending on the individual's [[comorbidity|comorbid]] medical issues. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Needs content]] | |||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Ischemic heart diseases]] | [[Category:Ischemic heart diseases]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Latest revision as of 15:01, 10 August 2013
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Relative Contribution of Myocardial Rupture as a Cause of Sudden Cardiac Death Following STEMI |
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Myocardial rupture overview On the Web |
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Risk calculators and risk factors for Myocardial rupture overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Myocardial rupture is a laceration or tearing of the walls of the ventricles or atria of the heart, of the interatrial or interventricular septum, of the papillary muscles or chordae tendineae or of one of the valves of the heart. It is most commonly seen as a serious sequelae of an acute myocardial infarction (heart attack).
Pathophysiology
The most common cause of myocardial rupture is a recent myocardial infarction, with the rupture typically occurring three to five days after infarction. Other causes of rupture include cardiac trauma, endocarditis (infection of the heart),[1][2] cardiac tumors, infiltrative diseases of the heart,[1] and aortic dissection.
Epidemiology and Demographics
The incidence of myocardial rupture has decreased in the era of urgent revascularization and aggressive pharmacological therapy for the treatment of an acute myocardial rupture. However, the decrease in the incidence of myocardial rupture is not uniform; there is a slight increase in the incidence of rupture if thrombolytic agents are used to abort a myocardial infarction.[3] On the other hand, if primary percutaneous coronary intervention is performed to abort the infarction, the incidence of rupture is significantly lowered.[4] The incidence of myocardial rupture if PCI is performed in the setting of an acute myocardial infarction is about 1 percent.[5]
Risk Factors
Risk factors for rupture after an acute myocardial infarction include female gender, advanced age of the individual, and a low body mass index. Other presenting signs associated with myocardial rupture include a pericardial friction rub, sluggish flow in the coronary artery after it is opened, the left anterior descending artery being the cause of the acute MI,[6] and delay of revascularization greater than 2 hours.
Natural History, Complications and Prognosis
The prognosis of myocardial rupture is dependant on a number of factors, including which portion of the myocardium is involved in the rupture. In one case series, if myocardial rupture involved the free wall of the left ventricle, the mortality rate was 100 percent.[7] Even if the individual survives the initial hemodynamic sequelae of the rupture, the 30 day mortality is still significantly higher than if rupture did not occur.[7]
Diagnosis
History and Symptoms
Symptoms of myocardial rupture are recurrent or persistent chest pain, syncope, and distension of jugular veins. 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 can be confirmed with echocardiography.
Physical Examination
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.
Echocardiography
The diagnosis can be confirmed with echocardiography.
Treatment
Medical Therapy
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 survive. In this setting, it may be reasonable to treat the rupture medically and delay or avoid surgery completely, depending on the individual's comorbid medical issues.
Surgery
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 survive. In this setting, it may be reasonable to treat the rupture medically and delay or avoid surgery completely, depending on the individual's comorbid medical issues.
References
- ↑ 1.0 1.1 Lin TH, Su HM, Voon WC, Lai HM, Yen HW, Lai WT, Sheu SH. (2006). "Association between hypertension and primary mitral chordae tendinae rupture". Am J Hypertens. 19 (1): 75–9. PMID 16461195.
- ↑ de Diego C, Marcos-Alberca P, Pai RK. (2006). "Giant periprosthetic vegetation associated with pseudoaneurysmal-like rupture" (PDF). Eur Heart J. 27 (8): 912. PMID 16569654.
- ↑ Becker RC, Gore JM, Lambrew C, Weaver WD, Rubison RM, French WJ, Tiefenbrunn AJ, Bowlby LJ, Rogers WJ. (1996). "A composite view of cardiac rupture in the United States National Registry of Myocardial Infarction". J Am Coll Cardiol. 27 (6): 1321–6. PMID 8626938.
- ↑ Moreno R, Lopez-Sendon J, Garcia E, Perez de Isla L, Lopez de Sa E, Ortega A, Moreno M, Rubio R, Soriano J, Abeytua M, Garcia-Fernandez MA. (2002). "Primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction". J Am Coll Cardiol. 39 (4): 598–603. PMID 11849857.
- ↑ Yip HK, Wu CJ, Chang HW, Wang CP, Cheng CI, Chua S, Chen MC. (2003). "Cardiac rupture complicating acute myocardial infarction in the direct percutaneous coronary intervention reperfusion era" (PDF). Chest. 124 (2): 565–71. PMID 12907544.
- ↑ Sugiura T, Nagahama Y, Nakamura S, Kudo Y, Yamasaki F, Iwasaka T. (2003). "Left ventricular free wall rupture after reperfusion therapy for acute myocardial infarction". Am J Cardiol. 92 (3): 282–4. PMID 12888132.
- ↑ 7.0 7.1 Yip HK, Wu CJ, Chang HW, Wang CP, Cheng CI, Chua S, Chen MC (2003). "Cardiac rupture complicating acute myocardial infarction in the direct percutaneous coronary intervention reperfusion era". Chest. 124 (2): 565–71. PMID 12907544. Retrieved 2012-04-08. Unknown parameter
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