Jarry G, Avinée P, Skonieczny M, Poulain H, Hermida J S, Rey J L, Quiret J C
Service de réanimation cardiaque, CHU Amiens.
Arch Mal Coeur Vaiss. 1991 Apr;84(4):563-7.
The authors report two cases of cardiac rupture during acute myocardial infarction successfully treated surgically. In the first case, rupture occurred 7 days after hospital admission for anteroseptal myocardial infarction. The patient developed sudden cardiogenic shock with signs of venous hypertension without left ventricular failure. The second patient was admitted for syncopal chest pain with transient hypotension which regressed after volume repletion and pressor amine therapy. On admission, the patient had signs of cardiac tamponade. The ECG showed recent inferolaterobasal myocardial infarction. In both cases the diagnosis was made by 2D echocardiography which showed voluminous circumferential pericardial effusions probably due to haemorrage, with an image very suggestive of a blood clot in the effusion of the second patient. The two patients underwent emergency cardiac surgery and both survived with a 4 and 1.5 month follow-up respectively. These two cases confirm the value of 2D echocardiography as an emergency bedside procedure for the diagnosis of cardiac rupture, especially when images of intrapericardial thrombosis are observed, as in our second patient. In addition, the first case raises once again the question of the role of late thrombolysis as a predisposing factor of cardiac rupture at a time when this technique is proposed up to 24 hours after the onset of symptoms.
作者报告了两例急性心肌梗死期间发生心脏破裂并成功接受手术治疗的病例。第一例，在因前间隔心肌梗死入院7天后发生破裂。患者突发心源性休克，伴有静脉高压体征，但无左心室衰竭。第二例患者因晕厥性胸痛伴短暂低血压入院，在补充容量和使用升压胺治疗后症状缓解。入院时，患者有心脏压塞体征。心电图显示近期下侧壁心肌梗死。两例均通过二维超声心动图确诊，显示大量心包积液，可能因出血所致，第二例患者的积液中有血凝块的图像极具提示性。两名患者均接受了急诊心脏手术，分别随访4个月和1.5个月后均存活。这两例证实了二维超声心动图作为诊断心脏破裂的急诊床边检查方法的价值，特别是当观察到心包内血栓形成的图像时，如我们的第二例患者。此外，第一例再次引发了在症状发作后长达24小时仍建议使用溶栓技术的情况下，晚期溶栓作为心脏破裂诱发因素的作用问题。
