Myocardial infarction and rupture of the heart: a macroscopic pathologic study.

From an anatomical point of view, the various elements which seem to individualize myocardial infarctions complicated by rupture are: a limited increase in the volume of the heart; a propensity for the rupture to follow the first infarction of a previously healthy cardiac muscle; a myocardial necrosis of sometimes small extension with clear limits and a destruction of the muscle so severe as to amount in two thirds of the cases to a variable parietal dissection; a lesser extension and diffusion of coronary stenosis; an ever-present and totally occlusive coronary thrombosis; an insignificant or absent substitutive circulation. Those strictly anatomical facts can be reason to extend the indications of a very early direct myocardial revascularization (almost a third of all cardiac ruptures occur within 24 hours) or to contemplate an infarctectomy after the eighth hour (the necroses are usually of a moderate size and well deliminated) if it appears possible to draw the "clinical profile" of those patients prone to cardiac rupture or to read the signs that may announce the likelihood of this dreadful complication.