Salem B I, Lagos J A, Haikal M, Gowda S
Department of Cardiology and Pathology, St. Luke's Hospital, St. Louis, Missouri.
Angiology. 1994 Nov;45(11):931-6. doi: 10.1177/000331979404501104.
Cardiac rupture complicating acute myocardial infarction (AMI) remains a serious diagnostic and therapeutic challenge. The authors present 27 consecutive patients who died from cardiac rupture following AMI. These included 22 patients from 1975 through 1983 (prethrombolytic era) and 5 patients from 1984 through 1992 (postthrombolytic era) and all had postmortem examination. There were 16 men and 11 women with a mean age of seventy-two years. Myocardial infarction was anterior/anterolateral in 10 and inferior/inferoposterior in 17. Cardiac rupture followed AMI within one day in 14 (52%), two to five days in 8 (30%), and six to fourteen days in 5 (18%). Chest pain followed by sudden hypotension leading to electromechanical dissociation was the common terminal event. Cardiopulmonary resuscitation was unsuccessful in all patients. Postmortem findings showed three-vessel coronary disease in 21 (78%) and two-vessel disease in 6 (22%). Isolated free left ventricular wall rupture was found in 22 (81%), was anterior/anterolateral in 13 (48%), posterior in 9 (33%), and in conjunction with interventricular septum or papillary muscle in 5 (18%). Patients encountered in this series were mostly elderly hypertensives with multivessel coronary disease and postinfarction angina. Furthermore, cardiac rupture commonly occurred within the first five days of AMI and cardiopulmonary resuscitation was uniformly unsuccessful. During the thrombolytic era at their institution, this complication is now being seen much less often. These observations suggest that such interventions are expected to have a favorable impact on reducing the incidence of this catastrophic event.
心肌梗死并发心脏破裂仍是一项严峻的诊断和治疗挑战。作者报告了27例急性心肌梗死后死于心脏破裂的连续病例。其中包括1975年至1983年（溶栓治疗前时代）的22例患者和1984年至1992年（溶栓治疗后时代）的5例患者，所有患者均进行了尸检。患者中男性16例，女性11例，平均年龄72岁。心肌梗死部位为前壁/前侧壁10例，下壁/下后壁17例。心脏破裂发生在急性心肌梗死后1天内的有14例（52%），2至5天的有8例（30%），6至14天的有5例（18%）。常见的终末事件是胸痛后突然出现低血压导致电机械分离。所有患者心肺复苏均未成功。尸检结果显示，21例（78%）有三支冠状动脉病变，6例（22%）有两支冠状动脉病变。孤立的左心室游离壁破裂22例（81%），其中前壁/前侧壁13例（48%），后壁9例（33%），合并室间隔或乳头肌破裂5例（18%）。本系列中的患者大多为老年高血压患者，患有多支冠状动脉病变和梗死后心绞痛。此外，心脏破裂通常发生在急性心肌梗死的前五天内，心肺复苏均未成功。在他们机构的溶栓治疗时代，这种并发症现在很少见。这些观察结果表明，此类干预措施有望对降低这一灾难性事件的发生率产生有利影响。
