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Sanchez-Jimenez E, Fanne RA, Levi Y, Saada M, Kobo O, Roguin A. Predictors, Outcomes and Impact of Mechanical Circulatory Support of Patients With Mechanical Complications After Acute Myocardial Infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 52:23-29. [PMID: 36849312 DOI: 10.1016/j.carrev.2023.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/28/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Despite early and currently effective epicardial coronary recanalization, the mortality rate after mechanical complication (MC) remains high, especially in cardiogenic shock. There is an increase in the use of mechanical circulatory support in patients with cardiogenic shock and MC, however, evidence is still scarce and most studies exclude patients with mechanical complications. METHODS Using the National Inpatient Sample database from 2015 to 2018 to identify patients with AMI, we aimed to determine the predictors and outcomes of patients with MC, subtypes and the use of MCS. RESULTS We identified 2,427,315 patients with AMI; 2345 (0.1 %) developed MC and of them 1320 (56.3 %) received MCS. Regarding subtypes, 960 (40.9 %) had ventricular septal rupture (VSR), 540 (23.0 %) papillary muscle rupture (PMR), 530 (22.6 %) pseudoaneurysm, and 315 (13.4 %) free wall rupture (FWR). Mortality was 12 times higher (OR: 11.663, CI: 10.582-12.855, p < 0.001) in patients with MC compared to patients without MC (49.7 % vs. 4.6 %, p < 0.001) and all subtypes of MC showed a significant increase in mortality. The use of MCS was associated with decreased mortality in PMR (46.2 % to 34.8 %, p = 0.009) and pseudoaneurysm (64.7 % to 42.1 %, p < 0.001), however, with higher mortality in VSR. CONCLUSIONS The incidence of MC after an AMI is very low, nonetheless the in-hospital mortality rate remains very high. It tends to occur more in older patients and with fewer comorbidities. The subtype with the highest frequency and highest mortality was VSR. The use of mechanical circulatory support was associated with better survival in PMR and pseudoaneurysm, but not overall survival.
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Affiliation(s)
- Erick Sanchez-Jimenez
- Cardiology Department, Hillel Yaffe Medical Center, Technion-Israel Institute of Technology, Hadera, Israel
| | - Rami Abu Fanne
- Cardiology Department, Hillel Yaffe Medical Center, Technion-Israel Institute of Technology, Hadera, Israel
| | - Yaniv Levi
- Cardiology Department, Hillel Yaffe Medical Center, Technion-Israel Institute of Technology, Hadera, Israel
| | - Majdi Saada
- Cardiology Department, Hillel Yaffe Medical Center, Technion-Israel Institute of Technology, Hadera, Israel
| | - Ofer Kobo
- Cardiology Department, Hillel Yaffe Medical Center, Technion-Israel Institute of Technology, Hadera, Israel
| | - Ariel Roguin
- Cardiology Department, Hillel Yaffe Medical Center, Technion-Israel Institute of Technology, Hadera, Israel.
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Duan MX, Zhao X, Li SL, Tao JZ, Li BY, Meng XG, Dai DP, Lu YY, Yue ZZ, Du Y, Rui ZA, Pang S, Zhou YH, Miao GR, Bai LP, Zhang QY, Zhao XY. Analysis of influencing factors for prognosis of patients with ventricular septal perforation: A single-center retrospective study. Front Cardiovasc Med 2022; 9:995275. [PMID: 36407434 PMCID: PMC9668866 DOI: 10.3389/fcvm.2022.995275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/18/2022] [Indexed: 09/08/2024] Open
Abstract
Background Ventricular septal rupture (VSR) is a type of cardiac rupture, usually complicated by acute myocardial infarction (AMI), with a high mortality rate and often poor prognosis. The aim of our study was to investigate the factors influencing the long-term prognosis of patients with VSR from different aspects, comparing the evaluation performance of the Gensini score, Sequential Organ Failure Assessment (SOFA) score and European Heart Surgery Risk Assessment System II (EuroSCORE II) score systems. Methods This study retrospectively enrolled 188 patients with VSR between Dec 9, 2011 and Nov 21, 2021at the First Affiliated Hospital of Zhengzhou University. All patients were followed up until Jan 27, 2022 for clinical data, angiographic characteristics, echocardiogram outcomes, intraoperative, postoperative characteristics and major adverse cardiac events (MACEs) (30-day mortality, cardiac readmission). Cox proportional hazard regression analysis was used to explore the predictors of long-term mortality. Results The median age of 188 VSR patients was 66.2 ± 9.1 years and 97 (51.6%) were males, and there were 103 (54.8%) patients in the medication group, 34 (18.1%) patients in the percutaneous transcatheter closure (TCC) group, and 51 (27.1%) patients in the surgical repair group. The average follow-up time was 857.4 days. The long-term mortality of the medically managed group, the percutaneous TCC group, and the surgical repair group was 94.2, 32.4, and 35.3%, respectively. Whether combined with cardiogenic shock (OR 0.023, 95% CI 0.001-0.054, P = 0.019), NT-pro BNP level (OR 0.027, 95% CI 0.002-0.34, P = 0.005), EuroSCORE II (OR 0.530, 95% CI 0.305-0.918, P = 0.024) and therapy group (OR 3.518, 95% CI 1.079-11.463, P = 0.037) were independently associated with long-term mortality in patients with VSR, and this seems to be independent of the therapy group. The mortality rate of surgical repair after 2 weeks of VSR was much lower than within 2 weeks (P = 0.025). The cut-off point of EuroSCORE II was determined to be 14, and there were statistically significant differences between the EuroSCORE II < 14 group and EuroSCORE II≥14 group (HR = 0.2596, 95%CI: 0.1800-0.3744, Logrank P < 0.001). Conclusion Patients with AMI combined with VSR have a poor prognosis if not treated surgically, surgical repair after 2 weeks of VSR is a better time. In addition, EuroSCORE II can be used as a scoring system to assess the prognosis of patients with VSR.
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Affiliation(s)
- Ming-Xuan Duan
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xi Zhao
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shao-Lin Li
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun-Zhong Tao
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo-Yan Li
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin-Guo Meng
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dong-Pu Dai
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan-Yu Lu
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhen-Zhen Yue
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Du
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zi-Ao Rui
- Department of Cardiology, Chest Hospital of Henan Province, Zhengzhou, China
| | - Shuo Pang
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan-Hang Zhou
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guang-Rui Miao
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin-Peng Bai
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qing-Yang Zhang
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao-Yan Zhao
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Department of Cardiology, Cardiovascular Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Kyaruzi M, Demirsoy E. Minimal invasive approach of post-MI ventricular septal defect repair and coronary artery revascularization via left anterior minithoracotomy. J Card Surg 2021; 36:4808-4810. [PMID: 34549458 DOI: 10.1111/jocs.16012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/08/2021] [Indexed: 11/27/2022]
Abstract
A 54-year-old male was admitted to our hospital with a prolonged dypsnea, orthopnoea, and chest pain that has lasted for almost 2 weeks. Physical examination revealed symptoms of heart failure. Transthoracic echocardiography revealed a ventricular septal defect located at the apical segment of the interventricular septum, mild mitral regurgitation, and hypokinesia of the apex of the left ventricle. Coronary angiography showed a critical proximal lesion of the left anterior descending artery. He was diagnosed with postmyocardial infarction ventricular septal defect. Our patient underwent minimal invasive coronary artery bypass and ventricular septal defect repair via left anterior minithoracotomy. Postoperative period was uneventful and our patient was released on a postoperative Day 7. Postoperative transthoracic echocardiography revealed no residue of repaired ventricular septal defect with improved left ventricular functions.
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Affiliation(s)
- Mugisha Kyaruzi
- Department of Cardiovascular Surgery, Kolan Hospital Group, Şişli, Istanbul, Turkey
| | - Ergun Demirsoy
- Department of Cardiovascular Surgery, Kolan Hospital Group, Şişli, Istanbul, Turkey
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Mathew A, Berry E, Tirou M, Kumar P. Left ventricular rupture: a rare complication and an unusual presentation. BMJ Case Rep 2020; 13:13/2/e231867. [PMID: 32079585 DOI: 10.1136/bcr-2019-231867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Myocardial infarction (MI) is a relatively common medical condition in the community. A rare complication of acute MI is left ventricular rupture (LV) rupture. This usually follows a transmural infarct. The incidence of this is 2%-4% and this usually happens within 3-7 days of MI. The anterolateral wall is involved in the majority of cases. Atypical presentations can occur several weeks after the initial event. Symptoms may mimic gastrointestinal disorder. The prognosis of this condition is very grim. However, with appropriate treatment, they can make an excellent recovery. The definitive treatment for this is surgical repair. We present the case of a 70-year-old man who had LV rupture and his clinical journey.
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Affiliation(s)
- Antony Mathew
- Emergency Department, Withybush General Hospital, Haverfordwest, Pembrokeshire, UK
| | - Eleanor Berry
- Emergency Department, Withybush General Hospital, Haverfordwest, Pembrokeshire, UK
| | - Malini Tirou
- Emergency Department, Withybush General Hospital, Haverfordwest, Pembrokeshire, UK
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Hajsadeghi S, Amirfarhangi A, Pakbaz M, Pazoki M, Tanha K. Postinfarction intramyocardial dissection, an interesting case report and systematic review. Echocardiography 2019; 37:124-131. [PMID: 31841238 DOI: 10.1111/echo.14565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/24/2019] [Accepted: 11/26/2019] [Indexed: 12/11/2022] Open
Abstract
Intramyocardial dissection (IMD) with ventricular septal rupture (VSR) following myocardial infarction (MI) is a rare subacute form of cardiac rupture. The evidence available in this regard is scarce. We aimed to share our experience and conduct a systematic review of previous cases. We searched the literature and performed a systematic review of previous cases. A total of 37 cases of IMD with VSR were included (1 our original and 36 literature cases). Mean age was 68 ± 8 years and 20 (54.1%) patients were male. Anterior and inferior MI were observed in 14 (37.8%) and 23 (62.2%) cases, respectively. The dissected area was the septum, RV, both septum and RV, or LV apex in 21 (56.8%), 9 (24.3%), 5 (13.5%), and 2 (5.4%), respectively. Apicoseptal and inferoseptal VSR were observed in 15 (40.5%) and 22 (59.5%) cases, respectively. At least one occluded artery was observed in 29 (90.6%) of cases. Reperfusion therapy was done for 15 (40.5%) cases before the VSR occurred. Surgery, percutaneous, and medical therapy were done for 26 (70.3%), 3 (8.1%), and 7 (18.9%) cases, respectively. The mortality rate was significantly higher in the medical versus surgical-treated group (85.7% versus 42.3%, P = .027). There was a trend to higher mortality in the group with dissection of both septum and RV (P = .15). We concluded that echocardiography has a critical role in diagnosing this complication. Surgery is mandatory in IMD with VSR.
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Affiliation(s)
- Shokoufeh Hajsadeghi
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Abdollah Amirfarhangi
- Department of Cardiovascular Disease, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Marziyeh Pakbaz
- Department of Cardiovascular Disease, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Pazoki
- Department of Cardiovascular Disease, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Kiarash Tanha
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Doberentz E, Wegner A, Geile J, Madea B. Natural cardiac death after stent implantation with iatrogenic injury of a coronary artery. Forensic Sci Med Pathol 2019; 16:366-369. [PMID: 31713779 DOI: 10.1007/s12024-019-00195-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 11/27/2022]
Abstract
In forensic practice, autopsies are regularly carried out in cases of suspected medical malpractice to determine whether a treatment resulted in death. Intraoperative deaths, as well as deaths shortly after an operation, can be particularly suspicious as iatrogenic. We report a case of a 75-year-old woman with a complaint of intermittent angina pectoris who underwent cardiac catheterization. Intra-interventionally, coronary artery dissection occurred and was stabilized by the placement of two stents. After this procedure, the patient suffered from chest pain. At 5.5 h after the procedure ended, the woman suddenly and unexpectedly died. At forensic autopsy, a hemopericardium with cardiac tamponade was found to have been caused by the rupture of a myocardial infarction that was several days old and had remained clinically unrecognized. This case report illustrates the importance of forensic autopsies in terms of external quality assurance in medicine.
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Affiliation(s)
- Elke Doberentz
- Institute of Legal Medicine, University of Bonn, Stiftsplatz 12, 53111, Bonn, Germany.
| | - Anja Wegner
- Institute of Legal Medicine, University of Bonn, Stiftsplatz 12, 53111, Bonn, Germany
| | - Julian Geile
- Institute of Legal Medicine, University of Bonn, Stiftsplatz 12, 53111, Bonn, Germany
| | - Burkhard Madea
- Institute of Legal Medicine, University of Bonn, Stiftsplatz 12, 53111, Bonn, Germany
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7
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Huang S, Frangogiannis NG. Anti-inflammatory therapies in myocardial infarction: failures, hopes and challenges. Br J Pharmacol 2018; 175:1377-1400. [PMID: 29394499 PMCID: PMC5901181 DOI: 10.1111/bph.14155] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 12/14/2022] Open
Abstract
In the infarcted heart, the damage-associated molecular pattern proteins released by necrotic cells trigger both myocardial and systemic inflammatory responses. Induction of chemokines and cytokines and up-regulation of endothelial adhesion molecules mediate leukocyte recruitment in the infarcted myocardium. Inflammatory cells clear the infarct of dead cells and matrix debris and activate repair by myofibroblasts and vascular cells, but may also contribute to adverse fibrotic remodelling of viable segments, accentuate cardiomyocyte apoptosis and exert arrhythmogenic actions. Excessive, prolonged and dysregulated inflammation has been implicated in the pathogenesis of complications and may be involved in the development of heart failure following infarction. Studies in animal models of myocardial infarction (MI) have suggested the effectiveness of pharmacological interventions targeting the inflammatory response. This article provides a brief overview of the cell biology of the post-infarction inflammatory response and discusses the use of pharmacological interventions targeting inflammation following infarction. Therapy with broad anti-inflammatory and immunomodulatory agents may also inhibit important repair pathways, thus exerting detrimental actions in patients with MI. Extensive experimental evidence suggests that targeting specific inflammatory signals, such as the complement cascade, chemokines, cytokines, proteases, selectins and leukocyte integrins, may hold promise. However, clinical translation has proved challenging. Targeting IL-1 may benefit patients with exaggerated post-MI inflammatory responses following infarction, not only by attenuating adverse remodelling but also by stabilizing the atherosclerotic plaque and by inhibiting arrhythmia generation. Identification of the therapeutic window for specific interventions and pathophysiological stratification of MI patients using inflammatory biomarkers and imaging strategies are critical for optimal therapeutic design.
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Affiliation(s)
- Shuaibo Huang
- The Wilf Family Cardiovascular Research Institute, Department of Medicine (Cardiology)Albert Einstein College of MedicineBronxNY10461USA
- Department of Cardiology, Changzheng HospitalSecond Military Medical UniversityShanghai200003China
| | - Nikolaos G Frangogiannis
- The Wilf Family Cardiovascular Research Institute, Department of Medicine (Cardiology)Albert Einstein College of MedicineBronxNY10461USA
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8
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Formica F, Mariani S, Singh G, D’Alessandro S, Messina LA, Jones N, Bamodu OA, Sangalli F, Paolini G. Postinfarction left ventricular free wall rupture: a 17-year single-centre experience. Eur J Cardiothorac Surg 2018; 53:150-156. [DOI: 10.1093/ejcts/ezx271] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Abstract
Patients with their first myocardial infarction (MI), who present to the emergency department many hours after the onset of chest pain, who appear to be improving but suddenly develop new chest pain and unexpected hypotension (with or without signs of cardiac tamponade), should be suspected of having ventricular free wall rupture (VFWR). The mainstay of treatment is surgery. These patients may be managed with the administration of fluids, cautious use of inotropes and echocardiographic scanning, which should be performed on an emergent basis, while being prepared to be moved to the emergency surgical suite. However, at no cost should surgery be delayed. This paper reviews the current literature of VFWR after MI, a condition which remains difficult to diagnose, in many aspects, to this day. The review examines the historical background, incidence, postulated risk factors, clinical presentation, investigations and management.
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Affiliation(s)
| | - N Nimbkar
- Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
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10
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Intramyocardial dissection with concomitant left ventricular aneurysm as a rare complication of myocardial infarction: a case report. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:632-5. [PMID: 27605945 PMCID: PMC4996839 DOI: 10.11909/j.issn.1671-5411.2016.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
We describe a rare case of a 60-year-old woman suffering from intramyocardial dissection and left ventricular aneurysm secondary to acute myocardial infarction. A rare form of ventricular septal rupture resulted from intramyocardial dissection deterioration, which was identified during echocardiographic follow-up. Surgical repair under beating-heart cardiopulmonary bypass was successful.
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Roberts WC, Burks KH, Ko JM, Filardo G, Guileyardo JM. Commonalities of cardiac rupture (left ventricular free wall or ventricular septum or papillary muscle) during acute myocardial infarction secondary to atherosclerotic coronary artery disease. Am J Cardiol 2015; 115:125-40. [PMID: 25456862 DOI: 10.1016/j.amjcard.2014.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 10/04/2014] [Indexed: 11/29/2022]
Abstract
Although mortality rates during acute myocardial infarction (AMI) continue to drop, cardiac rupture (left ventricular free wall [LVFW] or ventricular septum [VS] or papillary muscle [PM] or combination) remains relatively common. The aim was to identify commonalities among patients with AMI complicated by cardiac rupture. During a 22-year period (1993-2014) 64 patients hospitalized for AMI were studied and clinical and morphologic variables in those with (25 patients) - vs - those without (39 patients) cardiac rupture were compared, and previous reports on this topic were reviewed. Compared to the non-rupture cases, the rupture group was significantly older (71 years - vs - 60 years); had a much higher frequency of huge deposits of adipose tissue in the heart (floated in formaldehyde) (88% - vs - 20%) but a lower mean body mass index (28.2 Kg/m(2) - vs - 33.2 Kg/m(2)); a much lower frequency of healed myocardial infarct (scar) (4% - vs - 28%); a lower frequency of diabetes mellitus (24% - vs - 47%), and a higher frequency of thrombolytic therapy during the fatal AMI (32% - vs - 10%). None of the rupture cases had evidence of dilated left ventricular cavities or evidence of heart failure before the AMI complicated by rupture. In conclusion, cardiac rupture appears to account for a high percent of deaths during a first AMI. It most commonly occurs in patients with extremely fatty hearts and in those without evidence of prior heart failure.
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Affiliation(s)
- William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Texas; Department of Internal Medicine (Division of Cardiology), Baylor University Medical Center at Dallas, Texas; Department of Pathology, Baylor University Medical Center at Dallas, Texas.
| | - Kendall H Burks
- Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Texas
| | - Jong Mi Ko
- Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Texas
| | - Giovanni Filardo
- Department of Epidemiology, Office of Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas
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Honda S, Asaumi Y, Yamane T, Nagai T, Miyagi T, Noguchi T, Anzai T, Goto Y, Ishihara M, Nishimura K, Ogawa H, Ishibashi-Ueda H, Yasuda S. Trends in the clinical and pathological characteristics of cardiac rupture in patients with acute myocardial infarction over 35 years. J Am Heart Assoc 2014; 3:e000984. [PMID: 25332178 PMCID: PMC4323797 DOI: 10.1161/jaha.114.000984] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background There is little known about whether the clinical and pathological characteristics and incidence of cardiac rupture (CR) in patients with acute myocardial infarction (AMI) have changed over the years. Methods and Results The incidence and clinical characteristics of CR were investigated in patients with AMI, who were divided into 3 cohorts: 1977–1989, 1990–2000, and 2001–2011. Of a total of 5699 patients, 144 were diagnosed with CR and 45 survived. Over the years, the incidence of CR decreased (1977–1989, 3.3%; 1990–2000, 2.8%; 2001–2011, 1.7%; P=0.002) in association with the widespread adoption of reperfusion therapy. The mortality rate of CR decreased (1977–1989, 90%; 1990–2000, 56%; 2001–2011, 50%; P=0.002) in association with an increase in the rate of emergent surgery. In multivariable analysis, first myocardial infarction, anterior infarct, female sex, hypertension, and age >70 years were significant risk factors for CR, whereas impact of hypertension on CR was weaker from 2001 to 2011. Primary percutaneous coronary intervention (PPCI) was a significant protective factor against CR. In 64 autopsy cases with CR, myocardial hemorrhage occurred more frequently in those who underwent PPCI or fibrinolysis than those who did not receive reperfusion therapy (no reperfusion therapy, 18.0%; fibrinolysis, 71.4%; PPCI, 83.3%; P=0.001). Conclusions With the development of medical treatment, the incidence and mortality rate of CR have decreased. However, first myocardial infarction, anterior infarct, female sex, and old age remain important risk factors for CR. Adjunctive cardioprotection against reperfusion‐induced myocardial hemorrhage is emerging in the current PPCI era.
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Affiliation(s)
- Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.) Department of Advanced Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan (S.H., S.Y.)
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Takafumi Yamane
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Tadayoshi Miyagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Yoichi Goto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Masaharu Ishihara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (K.N.)
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.) Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (H.O.)
| | - Hatsue Ishibashi-Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.) Department of Advanced Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan (S.H., S.Y.)
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13
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Petrou E, Vartela V, Kostopoulou A, Georgiadou P, Mastorakou I, Kogerakis N, Sfyrakis P, Athanassopoulos G, Karatasakis G. Left ventricular pseudoaneurysm formation: Two cases and review of the literature. World J Clin Cases 2014; 2:581-586. [PMID: 25325071 PMCID: PMC4198413 DOI: 10.12998/wjcc.v2.i10.581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/21/2014] [Accepted: 07/29/2014] [Indexed: 02/05/2023] Open
Abstract
Left ventricular wall rupture (LVWR) comprises a complication of acute myocardial infarction (AMI). Acute LVWR is a fatal condition, unless the formation of a pseudoaneurysm occurs. Several risk factors have been described, predisposing to LVWR. High index of suspicion and imaging techniques, namely echocardiography and computed tomography, are the cornerstones of timely diagnosis of the condition. As LVWR usually leads to death, emergency surgery is the treatment of choice, resulting in significant reduction in mortality and providing favorable short-term outcomes and adequate prognosis during late follow-up. Herein, we present two patients who were diagnosed with LVWR following AMI, and subsequent pseudoaneurysm formation. In parallel, we review the aforementioned condition.
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14
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Marella P, Hussein H, Rajpurohit N, Garg R. Leaking heart: ticking time bomb! NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2013; 5:620-2. [PMID: 24350078 PMCID: PMC3842707 DOI: 10.4103/1947-2714.120802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Context: Cardiac rupture is a very important but under-recognized complication of acute myocardial infarction and usually happens within a week of the event. Sometimes it can be subacute and may not be typical of an acute blow out rupture. Hence careful evaluation is needed as a missed or delayed diagnosis can be fatal. An emergent echocardiogram may aid in immediate diagnosis. Surgery is the only treatment option and is mandatory despite the high mortality risk. Case Report: An elderly male presented with dizziness and hypotension. Based on the timeline of his symptomatology, electrocardiographic abnormalities and labs, a subacute cardiac rupture was suspected in the emergency room itself. A high index of suspicion is needed to diagnose cardiac rupture. Conclusion: Subacute cases can be missed easily as presentation may not be dramatic. They can rapidly progress to a blowout rupture increasing mortality risk heavily even with surgical treatment.
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Affiliation(s)
- Punnaiah Marella
- Department of Internal Medicine, Banner Estrella Medical Center, Phoenix, AZ, USA
| | - Hassan Hussein
- Department of Internal Medicine, West Valley Medical Center, Goodyear, AZ, USA
| | - Naveen Rajpurohit
- Department of Cardiology, Sanford Health, Sioux Falls, South Dakota, USA
| | - Rajeev Garg
- Department of Cardiology, Banner Estrella Medical Center, Phoenix, AZ, USA
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15
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Zhu XY, Qin YW, Han YL, Zhang DZ, Wang P, Liu YF, Xu YW, Jing QM, Xu K, Gersh BJ, Wang XZ. Long-term efficacy of transcatheter closure of ventricular septal defect in combination with percutaneous coronary intervention in patients with ventricular septal defect complicating acute myocardial infarction: a multicentre study. EUROINTERVENTION 2013; 8:1270-6. [DOI: 10.4244/eijv8i11a195] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Ng R, Yeghiazarians Y. Post myocardial infarction cardiogenic shock: a review of current therapies. J Intensive Care Med 2011; 28:151-65. [PMID: 21747126 DOI: 10.1177/0885066611411407] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cardiogenic shock is often a devastating consequence of acute myocardial infarction (MI) and portends to significant mortality and morbidity. Despite improvements in expediting the time to treatment and enhancements in available medical therapy and reperfusion techniques, cardiogenic shock remains the most common cause of mortality following MI. Post-MI cardiogenic shock most commonly occurs as a consequence of severe left ventricular dysfunction. Right ventricular (RV) MI must also be considered. Mechanical complications including acute mitral regurgitation, ventricular septal rupture, and ventricular free-wall rupture can also lead to cardiogenic shock. Rapid diagnosis of cardiogenic shock and its underlying cause is pivotal to delivering definitive therapy. Intravenous vasoactive agents and mechanical support devices may temporize the patient's hemodynamic status until definitive therapy by percutaneous or surgical intervention can be performed. Despite prompt management, post-MI cardiogenic shock mortality remains high.
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Affiliation(s)
- Ramford Ng
- University of California, San Francisco, CA 94143, USA
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17
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Van Dijk A, Vermond RA, Krijnen PAJ, Juffermans LJM, Hahn NE, Makker SP, Aarden LA, Hack E, Spreeuwenberg M, van Rossum BC, Meischl C, Paulus WJ, Van Milligen FJ, Niessen HWM. Intravenous clusterin administration reduces myocardial infarct size in rats. Eur J Clin Invest 2010; 40:893-902. [PMID: 20854280 DOI: 10.1111/j.1365-2362.2010.02345.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Clusterin (Apolipoprotein J), a plasma protein with cytoprotective and complement-inhibiting activities, localizes in the infarcted heart during myocardial infarction (MI). Recently, we have shown a protective effect of exogenous clusterin in vitro on ischaemically challenged cardiomyocytes independent of complement. We therefore hypothesized that intravenous clusterin administration would reduce myocardial infarction damage. METHODS Wistar rats undergoing experimental MI, induced by 40 min ligation of a coronary vessel, were treated with either clusterin (n=15) or vehicle (n=13) intravenously, for 3 days post-MI. After 4 weeks, hearts were analysed. The putative role of megalin, a clusterin receptor, was also studied. RESULTS Administration of human clusterin significantly reduced both infarct size (with 75 ± 5%) and death of animals (23% vehicle group vs. 0% clusterin group). Importantly, histochemical analysis showed no signs of impaired wound healing in the clusterin group. In addition, significantly increased numbers of macrophages were found in the clusterin group. We also found that the clusterin receptor megalin was present on cardiomyocytes in vitro which, however, was not influenced by ischaemia. Human clusterin co-localized with this receptor in vitro, but not in the human heart. In addition, using a megalin inhibitor, we found that clusterin did not exert its protective effect on cardiomyocytes through megalin. CONCLUSIONS Our results thus show that clusterin has a protective effect on cardiomyocytes after acute myocardial infarction in vivo, independent of its receptor megalin. This indicates that clusterin, or a clusterin derivate, is a potential therapeutic agent in the treatment of MI.
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18
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Ozer N, Aksoy H, Hazırolan T, Tulumen E, Deveci OS, Okutucu S, Abacı A, Özdoğan ME, Özmen F. An Unusual Case of a Giant Pseudoaneurysm Formation after Myocardial Infarction. Echocardiography 2010; 27:E83-6. [DOI: 10.1111/j.1540-8175.2010.01172.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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19
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López-Sendón J, Gurfinkel EP, Lopez de Sa E, Agnelli G, Gore JM, Steg PG, Eagle KA, Cantador JR, Fitzgerald G, Granger CB. Factors related to heart rupture in acute coronary syndromes in the Global Registry of Acute Coronary Events. Eur Heart J 2010; 31:1449-56. [PMID: 20231153 DOI: 10.1093/eurheartj/ehq061] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS To determine the incidence and factors associated with heart rupture (HR) in acute coronary syndrome (ACS) patients. METHODS AND RESULTS Among 60 198 patients, 273 (0.45%) had HR (free wall rupture, n = 118; ventricular septal rupture, n = 155). Incidence was 0.9% for ST-segment elevation myocardial infarction (STEMI), 0.17% for non-STEMI, and 0.25% for unstable angina. Hospital mortality was 58 vs. 4.5% in patients without HR (P < 0.001). The incidence was lower in STEMI patients with primary percutaneous coronary intervention (PCI) than in those without (0.7 vs. 1.1%; P = 0.01), but primary PCI was not independently related to HR in adjusted analysis (P = 0.20). Independent variables associated with HR included: ST-segment elevation (STE)/left bundle branch block; ST-segment deviation; female sex; previous stroke; positive initial cardiac biomarkers; older age; higher heart rate; systolic blood pressure/30 mmHg decrease. Conversely, previous MI and the use of low-molecular-weight heparin and beta-blockers during first 24 h were identified as protective factors for HR. CONCLUSION The incidence of HR is low in patients with ACS, although its incidence is probably underestimated. Heart rupture occurs more frequently in ACS with STE and is associated with high hospital mortality. A number of variables are independently related to HR.
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Affiliation(s)
- José López-Sendón
- Cardiology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28036 Madrid, Spain.
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20
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The rationale for cardiomyocyte resuscitation in myocardial salvage. J Mol Med (Berl) 2008; 86:1085-95. [PMID: 18563379 DOI: 10.1007/s00109-008-0362-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 04/17/2008] [Accepted: 04/21/2008] [Indexed: 12/27/2022]
Abstract
Clinical heart failure results from the cumulative loss of functioning myocardium from any cause. At the cellular level, cardiac myocytes die from three causes, individually or in combination: Necrosis occurs when external conditions are not sufficient to sustain minimal cellular functions, as with ischemia, and there is a general and unorganized breakdown of cell organelles, engendering an inflammatory response that may have harmful collateral tissue effects. Apoptosis, or cell suicide, occurs when specific external or internal conditions provoke a highly structured sequence of events to shut down cellular functions and remove the cell, with minimal consequences to surrounding tissue. Autophagy is a normal response to cell starvation that is induced under conditions of chronic metabolic or other stress. Current therapeutics, such as early myocardial revascularization after myocardial infarction, are focused exclusively upon minimizing cardiac myocyte necrosis and may even contribute to secondary apoptosis and autophagy. This review explores possible approaches to bring cardiac myocytes that are destined to die, back to life, i.e., cellular resuscitation. Two pro-apoptotic proteins in particular, Bnip3 and Nix, are transcriptionally upregulated specifically in response to myocardial ischemia and pathological hypertrophy and have been examined as therapeutic targets. In Bnip3 and Nix genetic mouse models, prevention of cardiac myocyte apoptosis in ischemic and hemodynamically overloaded hearts salvaged myocardium, minimized late ventricular remodeling, and enhanced ventricular performance. Cardiomyocyte resuscitation by preventing programmed cell death shows promise as an additive approach to minimizing necrosis for long-term prevention of heart failure.
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21
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Maffeʼ S, Zenone F, Paffoni P, Pardo NF, Dellavesa P, Perucca A, Parravicini U, Paino AM, Bielli M, Signorotti F, Zanetta M. Left ventricular pseudoaneurysm: an atypical case associated with a small ventricular septal defect. J Cardiovasc Med (Hagerstown) 2008; 9:195-200. [DOI: 10.2459/jcm.0b013e3281ac20ee] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Left ventricular lateral wall pseudoaneurysm. COR ET VASA 2007. [DOI: 10.33678/cor.2007.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Cardiac rupture is a complication of myocardial infarction with an exceedingly high mortality rate. Imaging modalities, such as echocardiography, have facilitated premortem diagnosis, thus increasing chances of survival. A review of pertinent literature is accompanied by a case report that details an episode of left ventricular free wall rupture and its successful outcome.
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Affiliation(s)
| | | | - Bruce Sussex
- Correspondence: Dr Bruce Sussex, Division of Cardiology, Health Sciences Complex, Room 1283, Memorial University, 300 Prince Phillip Drive, St John’s, Newfoundland and Labrador A1B 3V6. Telephone 709-777-7337, e-mail
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24
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Raposo L, Andrade MJ, Ferreira J, Aguiar C, Couto R, Abecasis M, Canada M, Jalles-Tavares N, da Silva JA. Subacute left ventricle free wall rupture after acute myocardial infarction: awareness of the clinical signs and early use of echocardiography may be life-saving. Cardiovasc Ultrasound 2006; 4:46. [PMID: 17118207 PMCID: PMC1664587 DOI: 10.1186/1476-7120-4-46] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Accepted: 11/22/2006] [Indexed: 12/28/2022] Open
Abstract
Left ventricular free wall rupture (LVFWR) is a fearful complication of acute myocardial infarction in which a swift diagnosis and emergency surgery can be crucial for successful treatment. Because a significant number of cases occur subacutely, clinicians should be aware of the risk factors, clinical features and diagnostic criteria of this complication. We report the case of a 69 year-old man in whom a subacute left ventricular free wall rupture (LVFWR) was diagnosed 7 days after an inferior myocardial infarction with late reperfusion therapy. An asymptomatic 3 to 5 mm saddle-shaped ST-segment elevation in anterior and lateral leads, detected on a routine ECG, led to an urgent bedside echocardiogram which showed basal inferior-wall akinesis, a small echodense pericardial effusion and a canalicular tract from endo to pericardium, along the interface between the necrotic and normal contracting myocardium, trough which power-Doppler examination suggested blood crossing the myocardial wall. A cardiac MRI further reinforced the possibility of contained LVFWR and a surgical procedure was undertaken, confirming the diagnosis and allowing the successful repair of the myocardial tear. This case illustrates that subacute LVFWR provides an opportunity for intervention. Recognition of the diversity of presentation and prompt use of echocardiography may be life-saving.
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Affiliation(s)
- Luís Raposo
- Cardiology Department, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Maria João Andrade
- Cardiology Department, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Jorge Ferreira
- Cardiology Department, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Carlos Aguiar
- Cardiology Department, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Rute Couto
- Cardiology Department, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Miguel Abecasis
- Cardiothoracic Surgery Department, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Manuel Canada
- Cardiology Department, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Nuno Jalles-Tavares
- Ressonância Magnética – Caselas – Bairro de Caselas, Rua Carolina Ângelo, 1400-045 Lisbon, Portugal
| | - José Aniceto da Silva
- Cardiology Department, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
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25
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Weissman G, Kwon CC, Shaw RK, Setaro JF. Free-wall rupture of the myocardium following infarction: a changing clinical portrait in the reperfusion era: a case report. Angiology 2006; 57:636-42. [PMID: 17067988 DOI: 10.1177/0003319706293152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Free wall rupture of the myocardium is an important complication and major cause of death following acute transmural (ST segment elevation) myocardial infarction. Pathologic changes on a cellular level may combine with mechanical stressors to weaken the myocardium postinfarction. Risk factors for myocardial rupture include advanced age, female gender, prior hyper-tension, first myocardial infarction, late presentation, lack of collateral blood flow, and persisting chest pain and ST segment elevations. Thrombolytic therapy does not increase risk of rupture when given early in myocardial infarction, but late thrombolytic therapy may heighten risk. Primary percutaneous coronary intervention for acute myocardial infarction has reduced the incidence of myocardial rupture compared to thrombolytic therapy. This advantage likely can be ascribed to higher rates of immediate reperfusion with catheter techniques, as well as to the avoidance of thrombolytic-mediated hemorrhagic transformation of the infarction zone. Careful regulation of blood pressure and pulse using nitrates and beta-adrenergic blockers may mitigate the tendency toward myocardial rupture. Early and accurate diagnosis based on clinical and echocardiographic evidence can lead to successful surgical treatment.
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Affiliation(s)
- Gaby Weissman
- Section of Cardiovascular Medicine, Yale University School of Medicine and Cardiothoracic Surgery, New Haven, CT, USA
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26
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Clarot F, Vaz E, Vicomte C, Gricourt C, Papin F, Proust B. Sudden death from a "broken heart" in a young woman. J Forensic Leg Med 2006; 14:172-4. [PMID: 16914361 DOI: 10.1016/j.jcfm.2006.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A case of ruptured myocardial infarct in a young woman with no previous medical history is presented, as well as a review of the literature and forensic aspects are discussed.
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Affiliation(s)
- F Clarot
- Rouen University Hospital, Department of Forensic Medicine, CHU Rouen-Charles, Nicolle-Rouen, France.
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27
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Tanaka M, Goto Y, Suzuki S, Morii I, Otsuka Y, Miyazaki S, Nonogi H. Postinfarction cardiac rupture despite immediate reperfusion therapy in a patient with severe aortic valve stenosis. Heart Vessels 2006; 21:59-62. [PMID: 16440151 DOI: 10.1007/s00380-005-0828-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2004] [Accepted: 02/26/2005] [Indexed: 10/25/2022]
Abstract
A 74-year-old woman with severe aortic valve stenosis (AS) was admitted to our hospital because of dyspnea on exertion. On day 2, she developed acute anterior wall myocardial infarction (MI) with ST elevation. Tissue plasminogen activator (tPA) was administered 10 min after the onset of chest pain, and emergency percutaneous coronary intervention was performed to induce coronary reperfusion after another 50 min. Five hours after MI onset, however, she suddenly went into electromechanical dissociation and died from cardiac rupture. This is the first case report of postinfarct cardiac rupture with severe AS occurring in spite of instituting immediate reperfusion therapy. High intraventricular pressure may be a critical risk factor for cardiac rupture in patients with AS complicated with acute MI. Further studies are required to clarify the risk and benefit of tPA administration before percutaneous coronary intervention and the necessity of the emergency correction of AS to prevent cardiac rupture.
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Affiliation(s)
- Makiko Tanaka
- Division of Cardiology, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan
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28
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Chen SSM, Ruengsakulrach P, Dick RJL, Buxton BF. Post-infarct left ventricular free wall rupture-not always a lethal complication of acute myocardial infarction. Heart Lung Circ 2005; 13:26-30. [PMID: 16352164 DOI: 10.1016/j.hlc.2004.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Post-myocardial infarction cardiac rupture is an important complication and cause of death in the period following myocardial infarction. It is rarely diagnosed before death. However, early diagnosis is crucial as successful treatment is possible with surgery. A successful outcome is sometimes compromised by difficult anatomy or an extensive infarct. Presentation, diagnosis and treatment of cardiac rupture is reviewed in this article, and is illustrated by five cases of cardiac rupture.
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Affiliation(s)
- Sylvia S M Chen
- Department of Cardiology, Epworth Hospital, Melbourne, Vic., Australia.
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29
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Lakkireddy DR, Khan IA, Nair CK, Korlakunta HL, Sugimoto JT. Pseudo-pseudoaneurysm of the left ventricle: a rare complication of acute myocardial infarction--a case report and literature review. Angiology 2005; 56:97-101. [PMID: 15678263 DOI: 10.1177/000331970505600114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rupture of the cardiac wall is usually a fatal complication of acute myocardial infarction within the first 2 weeks. However, in certain cases a ruptured ventricular wall is contained by overlying adherent pericardium called pseudoaneurysm, whereas a true aneurysm is one that is caused by scar formation resulting in thinning of the myocardium. The patients with pseudoaneurysm may survive until the aneurysm ruptures. In exceedingly rare instance, the rupture of the myocardium is not transmural but remains circumscribed within the ventricular wall itself, but in communication with the ventricular cavity. This finding is defined as pseudo-pseudoaneurysm. The authors report a case of postinfarction posterobasal pseudo-pseudoaneurysm along with review of the literature on the subject.
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30
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Anantharaman R, Walsh KP, Roberts DH. Combined catheter ventricular septal defect closure and multivessel coronary stenting to treat postmyocardial infarction ventricular septal defect and triple-vessel coronary artery disease: a case report. Catheter Cardiovasc Interv 2004; 63:311-3. [PMID: 15505846 DOI: 10.1002/ccd.20170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ventricular septal defect following acute myocardial infarction is a rare but life-threatening complication. Early surgical closure improves survival but carries a considerable risk. Percutaneous transcatheter closure is an alternative but experience to date is limited. We report a case of successful transcatheter closure of postmyocardial infarction ventricular septal defect (VSD) in a 55-year-old male with the Amplatzer muscular VSD occluder device and complete percutaneous revascularization with successful multivessel coronary stenting for three-vessel disease as a staged procedure. The technique and its potential use as an alternative to surgical approach for treatment of acute myocardial infarction and its complication (VSD) are discussed.
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31
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Wehrens XHT, Doevendans PA. Cardiac rupture complicating myocardial infarction. Int J Cardiol 2004; 95:285-92. [PMID: 15193834 DOI: 10.1016/j.ijcard.2003.06.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2003] [Revised: 06/03/2003] [Accepted: 06/09/2003] [Indexed: 11/21/2022]
Abstract
Rupture of the ventricular free wall is a leading cause of death in patients with acute myocardial infarction (MI). There are a number of risk indicators that are associated with cardiac rupture, such as female gender, old age, hypertension, and first MI. Typical symptoms of cardiac rupture are recurrent or persistent chest pain, syncope, and distension of jugular veins. Electrocardiographic signs may include sinus tachycardia, new Q-waves in 2 or more leads, persistent or recurrent ST segment elevation, deviation of expected evolutionary T-wave pattern, and electromechanical dissociation in end-stage cases. Once patients at risk have been identified using clinical symptoms and electrocardiographic signs, a fast and sensitive diagnostic test to confirm cardiac rupture is transthoracic echocardiography (TTE). New insights in the etiology of subacute myocardial rupture suggests that defective cardiac remodeling may predispose the heart for rupture. The matrix metalloproteinase (MMP) system has been shown to play an important role in cardiac extracellular matrix (ECM) remodeling and cardiac rupture. Current therapy of cardiac rupture consists mainly of surgery, and conservative management with hemodynamic monitoring, prolonged bed rest, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors in selected cases.
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Affiliation(s)
- Xander H T Wehrens
- Center for Molecular Cardiology, College of Physicians and Surgeons of Columbia University, 630W 168th Street, P and S 9-401, New York, NY 10032, USA
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Daya SK, Tan D, Tolerico PH, Gowda RM, Khan IA. Survival of an octogenarian after rupture of the left ventricular free wall caused by myocardial infarction. Tex Heart Inst J 2004; 31:178-80. [PMID: 15212133 PMCID: PMC427382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Left ventricular free wall rupture is an uncommon complication after a myocardial infarction that is associated with a high mortality rate from pericardial tamponade, especially in the elderly. Early recognition and management of this clinical entity affects the outcome; therefore, a high index of suspicion is imperative. We present a case of an 80-year-old man admitted with myocardial infarction, who had subsequent findings of left ventricular free wall rupture complicated by pericardial tamponade. Emergent surgical repair led to successful recovery. A brief overview of the clinical presentation, diagnosis, and management of this challenging and potentially fatal complication is presented.
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Birnbaum Y, Chamoun AJ, Anzuini A, Lick SD, Ahmad M, Uretsky BF. Ventricular free wall rupture following acute myocardial infarction. Coron Artery Dis 2003; 14:463-70. [PMID: 12966268 DOI: 10.1097/00019501-200309000-00008] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Ventricular free wall rupture remains a dreaded complication of acute myocardial infarction. A dramatic fatal presentation is not universal and if recognized early, especially in its sub-acute form, a therapeutic intervention may be lifesaving. Changing trends in its natural history and the previously described pathological subtypes have emerged since the advent of thrombolysis. Although frequently unpredictable, certain clinical, echocardiographic and electrocardiographic signs should suggest the diagnosis. Moreover, knowledge of predisposing risk factors and a high index of suspicion are helpful in early recognition of this complication. In recent years, several different therapeutic approaches have been described including percutaneous seals and surgical mechanical closure of ventricular free wall rupture. In this review, we sought to highlight established and debatable aspects of this pathology to hopefully enhance prompt diagnosis and treatment by all clinicians caring for patients suffering acute myocardial infarction.
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Affiliation(s)
- Yochai Birnbaum
- Division of Cardiology, Department of Internal Medicine, University of Texas Medical Branch, 5106 John Sealy Annex, 301 University Boulevard, Galveston, TX 77555-0553, USA.
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Goldstein JA, Casserly IP, Balzer DT, Lee R, Lasala JM. Transcatheter closure of recurrent postmyocardial infarction ventricular septal defects utilizing the Amplatzer postinfarction VSD device: a case series. Catheter Cardiovasc Interv 2003; 59:238-43. [PMID: 12772250 DOI: 10.1002/ccd.10510] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The initial therapy for postmyocardial infarction ventricular septal defects is surgical repair of the defect. Unfortunately, a significant number of patients develop recurrent ventricular septal defects (VSDs) following operative repair. Transcatheter closure offers an alternative to reoperation in these critically ill patients. We present a series of four patients in whom recurrent ventricular septal defects were closed using an Amplatzer VSD device.
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Affiliation(s)
- Jeffrey A Goldstein
- Division of Cardiovascular Medicine, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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36
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Giugliano GR, Giugliano RP, Gibson CM, Kuntz RE. Meta-analysis of corticosteroid treatment in acute myocardial infarction. Am J Cardiol 2003; 91:1055-9. [PMID: 12714146 DOI: 10.1016/s0002-9149(03)00148-6] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Acute and chronic inflammation play a central role in the pathophysiology of atherosclerosis. Corticosteroids are the gold standard anti-inflammatory agent and may have a role in treating acute myocardial infarction. However, concern exists regarding the potential for impaired wound healing and wall thinning. The MEDLINE and PreMEDLINE databases were searched for articles from 1966 through May 2002. A total of 186 articles and 16 English-language publications were identified. A meta-analysis of mortality in controlled trials was performed. Sensitivity analyses and 2 tests for publication bias were used to test the robustness of the results. Sixteen studies involving 3,793 patients were reviewed. Most studies were small (<100 patients) and revealed conflicting efficacy using surrogate outcome measures, such as infarct size. No clear association with myocardial rupture was observed. Meta-analysis of 11 controlled trials (2,646 patients) revealed a 26% decrease in mortality with corticosteroids (odds ratio 0.74, 95% confidence interval [CI] 0.59 to 0.94; p = 0.015). Sensitivity analyses limited to large studies and randomized controlled trials revealed odds ratios of 0.76 (95% CI 0.53 to 1.09) and 0.95 (95% CI 0.72 to 1.26), respectively. Two tests revealed no evidence for publication bias. Thus, the review of available clinical studies demonstrated no harm and a possible mortality benefit of corticosteroids in acute myocardial infarction.
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Affiliation(s)
- Gregory R Giugliano
- Division of Clinical Biometrics, Brigham & Women's Hospital, Boston, Massachusetts 02115, USA.
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37
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Nappi G, De Santo LS, Torella M, Della Corte A, Maresca L, Romano G, Cotrufo M. Treatment strategies for postinfarction left ventricular free wall rupture: stabilization with peri-operative IABP and off-pump repair. Int J Artif Organs 2003; 26:346-50. [PMID: 12757034 DOI: 10.1177/039139880302600410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Perioperative management of post-infarction left ventricular free wall rupture (LVFWR) is not clearly standardized and surgical repair is the only therapeutic option. Role of off-pump surgery and stabilization with perioperative intraaortic balloon pumping (IABP) were here analysed. METHODS Seven patients underwent surgery for LVFWR between 1990 and 2002. Clinical picture included electromechanical dissociation (3 patients) and sudden hypotension (4 patients). Except in one patient who was reanimated through femoro-femoral cardiopulmonary bypass, off-pump repair through on-lay patching technique was always performed. IABP was employed in the immediate postoperative period in five cases. RESULTS A satisfactory hemodynamic state was restored in all cases and there were no reoperations for bleeding or rerupture. Hospital survival was 100%. One patient underwent successful surgical myocardial revascularization two months after LVFWR. Two patients died at follow-up. The survivors present with good NYHA and CCS functional classes. CONCLUSIONS When the anatomy of the LVFWR is favourable, off-pump external patching repair proves a good choice. Postoperative IABP provides satisfactory hemodynamic support.
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Affiliation(s)
- G Nappi
- Department of Cardio-Thoracic and Respiratory Sciences, Second University of Naples, V. Monaldi Hospital, Naples, Italy.
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38
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Hutchins KD, Skurnick J, Lavenhar M, Natarajan GA. Cardiac rupture in acute myocardial infarction: a reassessment. Am J Forensic Med Pathol 2002; 23:78-82. [PMID: 11953501 DOI: 10.1097/00000433-200203000-00017] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiac rupture as a complication of acute myocardial infarction (AMI) has been described as occurring infrequently. Because of the recent dramatic decrease in autopsy rates, the authors believe that current studies do not accurately represent the frequency of this catastrophic complication. Autopsy protocols and archived histologic slides of patients with AMI were retrospectively reviewed to determine whether the frequency of cardiac rupture, as a complication of AMI, is altered when a non-hospital-based patient cohort after autopsy is evaluated. This review yielded 153 cases of 41 women and 112 men, whose postmortem examinations revealed gross and histologic evidence of AMI. Cardiac rupture was present in 30.7% of these cases. Of the 47 patients with rupture, 35 had no relevant medical history. The remaining 12 patients had various medical conditions. None of the patients in the rupture group had previously treated symptoms related to coronary artery conditions. Whereas women constituted 26.8% of the total AMI group, they had a cardiac rupture rate of 61%. By contrast, men with AMI had a cardiac rupture rate of 19.6%. All patients in the cardiac rupture group had heart weights over the predicted expected weight as a function of body weight. Age, gender, and heart weight were significant factors associated with cardiac rupture, whereas body mass index was not significantly related. When these factors were evaluated jointly, age was a significant explanatory factor for rupture among both men and women, whereas body mass index and heart weight were significant for men but not for women. When the rupture sites occurred on the left ventricular myocardium, the anterior wall was affected in 21 cases (45%), the posterior wall in 18 (38%), the lateral wall in 4 (9%), and the apex in 3 (6%). The right ventricular myocardium ruptured in 1 case (2%). Most of the patients had severe multivessel coronary artery disease. Histologic study of the specimens showed that the majority of ruptures occurred between 24 and 72 hours after myocardial infarction. This study showed a frequency of cardiac rupture of 30.7% in patients with AMI and sudden death according to medical examiner's records. These findings confirm and reinforce the importance of postmortem examination and autopsy as an adjunct to clinical medical practice.
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Affiliation(s)
- Kenneth D Hutchins
- Regional Medical Examiner Office, Edwin H. Albano Institute of Forensic Sciences, Newark, New Jersey 07103, USA.
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39
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Khalil ME, Heller EN, Boctor F, Brown EJ, Alhaddad IA. Ventricular free wall rupture in acute myocardial infarction. J Cardiovasc Pharmacol Ther 2001; 6:231-6. [PMID: 11584329 DOI: 10.1177/107424840100600303] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Despite a progressive reduction in acute myocardial infarction mortality over the years, death related to ventricular free wall rupture has not changed. This is mostly related to the catastrophic presentation and death within minutes in the majority of these patients. Once rupture is suspected, bedside echocardiography should be performed immediately, followed by pericardiocentesis and repair of the rupture site as quickly as possible. Measures to prevent cardiac rupture include the administration of beta-blockers and angiotensin-converting enzyme inhibitors unless contraindications exist, and the avoidance of steroidal and nonsteroidal anti-inflammatory agents such as ibuprofen and indomethacin.
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Affiliation(s)
- M E Khalil
- Cardiology Division, Department of Medicine, Johns Hopkins University Hospital, 600 N Wolfe Street, Baltimore, MD 21287, USA
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40
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Figueras J, Cortadellas J, Domingo E, Soler-Soler J. Survival following self-limited left ventricular free wall rupture during myocardial infarction. Management differences between patients with or without pseudoaneurysm formation. Int J Cardiol 2001; 79:103-11; discussion 111-2. [PMID: 11461727 DOI: 10.1016/s0167-5273(01)00415-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The clinical, angiographic and therapeutic features of eight patients who developed a left ventricular pseudoaneurysm (PA) after an acute myocardial infarction (AMI) and those of 25 who did not develop this complication following a medically managed left ventricular free wall rupture (FWR) were compared. These 25 patients were treated with pericardiocentesis, extended rest and strict blood pressure control. Most patients with FWR or PA had a first AMI and absence of overt heart failure. Both groups had a comparable age, frequency of systemic hypertension and extent of coronary disease. Pericardial effusion (> or =10 mm) was documented in all patients with FWR and in two of the three with PA with this information. Twenty four patients with FWR were hospitalized within the first 48 h (96%) but only three of those with PA (37.5%, P<0.002). Moreover, in patients with PA, a FWR was not suspected during AMI and, as opposed to those with FWR, they did not undergo a strict blood pressure control or a restriction of physical activity following AMI. Also, beta blockers were administered to 15 patients with FWR (60%) but to only one with PA (11%, P<0.02). Our findings suggest that failure to recognise a self limited FWR during AMI and to provide adequate control of blood pressure and physical exercise during the acute phase and the early weeks postinfarction, are likely to favor development of PA.
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Affiliation(s)
- J Figueras
- Unitat Coronària, Servei de Cardiologia, Hospital General Vall d'Hebron, Barcelona, Spain.
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41
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Cardiac rupture – experience-based cardiology. Int J Cardiol 2001. [DOI: 10.1016/s0167-5273(01)00416-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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42
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Nijmeijer R, Lagrand WK, Visser CA, Meijer CJ, Niessen HW, Hack CE. CRP, a major culprit in complement-mediated tissue damage in acute myocardial infarction? Int Immunopharmacol 2001; 1:403-14. [PMID: 11367525 DOI: 10.1016/s1567-5769(00)00044-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- R Nijmeijer
- ICaR-VU, University Hospital Vrije Universiteit, Amsterdam, Netherlands.
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43
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Figueras J, Cortadellas J, Soler-Soler J. Left ventricular free wall rupture: clinical presentation and management. Heart 2000; 83:499-504. [PMID: 10768896 PMCID: PMC1760810 DOI: 10.1136/heart.83.5.499] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- J Figueras
- Unitat Coronària, Servei de Cardiologia, Hospital General Vall d'Hebron, P Vall d'Hebron 119-129, Barcelona 08035, Spain
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44
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Holmberg M, Holmberg S, Herlitz J. Incidence, duration and survival of ventricular fibrillation in out-of-hospital cardiac arrest patients in sweden. Resuscitation 2000; 44:7-17. [PMID: 10699695 DOI: 10.1016/s0300-9572(99)00155-0] [Citation(s) in RCA: 165] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED The chance of survival from ventricular fibrillation (VF) is up to ten times higher than those with other cardiac arrest rhythms. To calculate the effect of out-of-hospital resuscitation organisations on survival, it is necessary to know the percentage of cardiac arrest patients initially in VF and the relationship between delay time to defibrillation and survival. AIM To study the incidence of VF at the time of cardiac arrest and on first ECG, the duration of VF and the relation between time to defibrillation and survival. METHOD The Swedish Cardiac Arrest Registry has collected standardised reports on out-of-hospital cardiac arrests from ambulance organisations in Sweden, serving 60% of the Swedish population. RESULTS In 14065 cases of out-of-hospital cardiac arrest collected between 1990 and 1995, resuscitation was attempted in 10966 cases. INCIDENCE The first ECG showed VF in 43% of all patients. The incidence of VF at the time of cardiac arrest was estimated to be 60-70% in all patients and 80-85% in the cases with probable heart disease. DURATION The estimated disappearance rate of VF was slow. Thirty minutes after collapse approximately 40% of the patients were in VF. SURVIVAL Overall survival to 1 month was only 1.6% for patients with non-shockable rhythms and 9.5% for patients found in VF. With increasing time to defibrillation, the survival rate fell rapidly from approximately 50% with a minimal delay to 5% at 15 min. CONCLUSIONS This study suggests a high initial incidence of VF among out-of-hospital cardiac arrest patients and a slow rate of transformation into a non-shockable rhythm. The survival rate with very short delay times to defibrillation was approximately 50%, but decreased rapidly as the delay increased.
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Affiliation(s)
- M Holmberg
- Department of Cardiology, Sahlgrenska University Hospital, SE-413 45, Göteborg, Sweden.
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45
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Yoshino H, Yotsukura M, Yano K, Taniuchi M, Kachi E, Shimizu H, Udagawa H, Kajiwara T, Ishikawa K. Cardiac rupture and admission electrocardiography in acute anterior myocardial infarction: implication of ST elevation in aVL. J Electrocardiol 2000; 33:49-54. [PMID: 10691174 DOI: 10.1016/s0022-0736(00)80100-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study determines the usefulness of electrocardiography in the emergency room for assessing the risk of cardiac rupture after acute anterior myocardial infarction (MI). The presence of ST segment elevation on the admission 12-lead electrocardiography was evaluated in 325 consecutive anterior MI patients. A forward-stepwise logistic regression analysis for cardiac rupture was performed with the covariates of age, gender, hypertension, history of MI, reperfusion therapy by coronary angioplasty, and ST segment elevations in leads I, aVL, V1-V6. Cardiac rupture occurred in 16 patients, including 7 with left ventricular free wall rupture (FWR) and 9 with ventricular septal perforation (VSP). For FWR, ST elevation in lead aVL was the only independent predictor (odds ratio = 12.1, P = .0215). For VSP, female gender (odds ratio = 5.32, P = .0201) was the independent predictor. In conclusion, in patients with acute anterior MI, ST segment elevation in lead aVL on the admission electrocardiography is a significant risk factor for left ventricular FWR.
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Affiliation(s)
- H Yoshino
- Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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46
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Pluenneke A, Stoler RC, Roberts WC. Chest Pain. Proc AMIA Symp 1999. [DOI: 10.1080/08998280.1999.11930201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Anne Pluenneke
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Robert C. Stoler
- Division of Cardiology, Baylor University Medical Center, Dallas, Texas
| | - William C. Roberts
- Baylor Cardiovascular Institute, Baylor University Medical Center, Dallas, Texas
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47
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Shah J, Kolvekar S, Murday A. Excision of a false left ventricular aneurysm. J R Soc Med 1999; 92:530-1. [PMID: 10692907 PMCID: PMC1297395 DOI: 10.1177/014107689909201011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J Shah
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
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48
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Marcì M, Ajello A, Di Francesco M, Floresta AM, Lojacono F, Battaglia A. Echocardiographic Diagnosis of Subacute Ventricular Wall Rupture Complicating Acute Myocardial Infarction. Echocardiography 1999; 16:575-577. [PMID: 11175190 DOI: 10.1111/j.1540-8175.1999.tb00106.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Rupture of ventricular wall is one of the most threatening complications of acute myocardial infarction. As a rule, it is rapidly lethal, and a precise diagnosis is seldom possible. On the contrary, in the so-called subacute ruptures (about one third of all cases), patients can survive for several hours, allowing time for diagnosis and immediate surgical intervention. We report here the case of one patient with subacute cardiac rupture who was diagnosed with echocardiography and successfully treated with pericardiocentesis and surgery.
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49
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Okabe M, Fukuda K, Arakawa K. Postmortem evaluation of morphologic changes in the infarcted myocardium that predict ventricular septal rupture in acute anteroseptal infarction. JAPANESE CIRCULATION JOURNAL 1999; 63:485-9. [PMID: 10406590 DOI: 10.1253/jcj.63.485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although thinning of the ventricular wall due to infarct expansion (septal aneurysm) may contribute to ventricular septal rupture (VSR), spatial factors predisposing to this mechanical complication have not been fully demonstrated. To identify the morphologic predictors of VSR, a retrospective postmortem study was performed on 17 hearts with acute anteroseptal myocardial infarction, comprising 7 with VSR and 10 without rupture. Infarct size and the extent of wall thinning were quantified. Wall thinning was defined as a decrease of less than 50% of thickness of the noninfarcted wall. The total infarct size did not differ among the groups. In the free wall (FW), the infarct was smaller in hearts with VSR than in those with a ruptured FW (p<0.05) or no rupture (p<0.01). The septal involvement was more extensive in patients with VSR than in those with FW rupture (p<0.05). Septal thinning was more extensive in hearts with VSR than in those with FW rupture (p<0.05) or non-rupture (p<0.05). A combination of a small infarct of the FW and a large septal infarct may contribute to the formation of septal aneurysm, which is believed to predispose to VSR. The presence of a small infarct of the anterior septum may be another setting for postinfarction septal rupture.
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Affiliation(s)
- M Okabe
- Department of Internal Medicine, School of Medicine, Fukuoka University, Japan
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50
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Abstract
CHD in the elderly population will continue to be a source of major concern because of the increasing costs entailed and uncertainties about how the widespread array of diagnostic and therapeutic interventions, often expensive and sometimes hazardous, should be applied. Financial, political, and health policy decisions will continue to occupy much attention, but it is likely that philosophic considerations about aging and death, both from the individual and the societal perspective, will be of paramount importance of deciding how the substantial resources available to the elderly will be used. Randomized, controlled trials are unlikely to play a major role in resolution of management dilemmas in the elderly because of the extraordinary heterogeneity in this population. Registries (databases) involving carefully prospectively collected key variables are likely to be a more effective approach. Critical characterization of complications of procedures, adverse drug reactions, and collection of follow-up data on functional status are among the critical questions, and these can be answered by registry studies. Algorithms and clinical rules developed in younger cohorts are not directly transferable to the elderly cardiovascular patients, further emphasizing the need for prospectively collected, syndrome-specific data. Treatments convincingly demonstrated to reduce mortality in absolute terms more in the elderly than in the young are underused. The heterogeneity of aging emphasizes the wide variability in patients' ability to withstand the stress of procedures and complications of disease and makes clear the need to consider physiologic reserve and biologic age rather than chronology. With better characterization of biologic age and physiologic reserve, more precise estimates of outcomes of therapies and interventions can be made, and patients can be given better information and with their families have more realistic expectations. Better-informed decisions will result. Biologic age will be multifactorial, involving cognitive, emotional, physical, and nutritional attributes as well as specific organ function (lung, kidney, liver) because no single feature can characterize the total elderly patient. The concept of competing risks among the cardiovascular disease being treated, comorbidity, risks of study, and life expectancy will evolve because even the most successful therapy will have limited effect on longevity in the very old. Although important research at the cellular and molecular level will characterize and provide better understanding of the aging process, it is not likely that this basic information will be immediately useful in the management of the large number of elderly patients with major cardiovascular disease. Preventive measures, including physical exercise, mental stimulation, avoidance of depression, good nutrition, and abstinence from tobacco use, are useful approaches to postpone or ameliorate the consequences of aging and allow patients to tolerate cardiovascular diseases better when they become manifest.
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Affiliation(s)
- G C Friesinger
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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