Carnevali R, Chiesa F, Rossati M, Longoni F
Minerva Med. 1981 Apr 2;72(13):819-24.
24 cases of cardiac rupture (CR) (12%) were found in 200 necropsies of patients who died from acute myocardial infarction (AMI). Examination of the various factors that may affect the onset of this complication showed that age, sex, the site of AMI, the presence of coronary thrombosis, the association of persistent arterial hypertension, diabetes mellitus or previous angina syndrome and anticoagulant and corticosteroid treatment are insignificant. On the other hand, previous myocardial infarction would appear to reduce incidence considerably. CR was much more frequent in the first 3-4 days after onset of AMI and never occurred more than 21 days after. An important premonitory sign is persistent precordial pain in the absence of pericardial friction. Cardiokinetic therapy was used in 70% of the CR cases examined here. Over the past decade, the frequency of CR secondary to AMI has risen appreciably and it is hypothesised that this increase may have been influenced by the readiness with which cardiokinetics are employed now during AMI, often in very high doses. Particularly in the case of patients at high CR risk, it is considered that cardiokinetic therapy should only be employed in cases of clear cardiac insufficiency, in small, fragmented doses and after diuretics and vasodilators have proved ineffective. Such patients can also usefully be transferred to specialist wards for emergency surgery or preventive infarctectomy.
在200例死于急性心肌梗死（AMI）的患者尸检中，发现24例心脏破裂（CR）（占12%）。对可能影响该并发症发生的各种因素进行检查发现，年龄、性别、AMI部位、冠状动脉血栓形成情况、持续性动脉高血压、糖尿病或既往心绞痛综合征的合并情况以及抗凝和皮质类固醇治疗并无显著影响。另一方面，既往心肌梗死似乎会显著降低发病率。CR在AMI发病后的头3 - 4天更为常见，且从未在发病后超过21天发生。一个重要的先兆症状是在心包摩擦音缺失的情况下持续的心前区疼痛。在这里检查的70%的CR病例中使用了心脏动力学疗法。在过去十年中，AMI继发CR的发生率明显上升，据推测，这种增加可能受到现在在AMI期间经常大剂量使用心脏动力学疗法的影响。特别是对于CR高风险患者，认为仅在明确存在心脏功能不全的情况下，以小剂量、分次给药且在利尿剂和血管扩张剂已证明无效后才应使用心脏动力学疗法。此类患者也可有益地转至专科病房进行急诊手术或预防性梗死切除术。
