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| {{Infobox_Disease | | {{Infobox_Disease |
| | Name = Myocardial rupture | | | Name = Myocardial rupture |
| | Image = Myocardial rupture 1.jpg | | | Image = Ventricular septal rupture1.jpg |
| | Caption = | | | Caption = Ventricular septum rupture at posterior wall |
| | DiseasesDB =
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| | ICD10 = {{ICD10|I|23|3|i|20}}-{{ICD10|I|23|5|i|20}}
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| | MedlinePlus =
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| | eMedicineSubj = med
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| | eMedicineTopic = 1571
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| | MeshID = D006341
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| }} | | }} |
| {{SI}}
| | '''For patient information, click [[Heart attack (patient information)|here]]''' |
| {{WikiDoc Cardiology Network Infobox}}
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| {{CMG}}
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| '''Associate Editor-In-Chief:''' {{CZ}}
| | {{Myocardial rupture}} |
| | {{CMG}}; {{AOEIC}} {{CZ}} {{MS}} |
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| {{Editor Help}} | | {{SK}} free wall rupture, ventricular septal rupture, VSR |
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| ==Overview== | | ==[[Myocardial rupture overview|Overview]]== |
| '''Myocardial rupture''' is a laceration or tearing of the walls of the [[Ventricle (heart)|ventricle]]s or [[atria]] of the [[heart]], of the [[interatrial septum|interatrial]] or [[interventricular septum]], of the [[papillary muscle]]s or [[chordae tendineae]] or of one of the [[heart valve|valves of the heart]]. It is most commonly seen as a serious sequelae of an acute [[myocardial infarction]] (heart attack).
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| ==Incidence== | | ==[[Myocardial rupture classification|Classification]]== |
| The incidence of myocardial rupture has decreased in the era of urgent revascularization and aggressive pharmacological therapy for the treatment of an acute myocardial rupture. However, the decrease in the incidence of myocardial rupture is not uniform; there is a slight increase in the incidence of rupture if thrombolytic agents are used to abort a myocardial infarction.<ref name="Becker-1996">{{cite journal | author=Becker RC, Gore JM, Lambrew C, Weaver WD, Rubison RM, French WJ, Tiefenbrunn AJ, Bowlby LJ, Rogers WJ. | title=A composite view of cardiac rupture in the United States National Registry of Myocardial Infarction. | journal=J Am Coll Cardiol | year=1996 | volume=27 | issue=6 | pages=1321-6 | id=PMID 8626938}}</ref> On the other hand, if [[percutaneous coronary intervention|primary percutaneous coronary intervention]] is performed to abort the infarction, the incidence of rupture is significantly lowered.<ref name="Moreno-2002">{{cite journal | author=Moreno R, Lopez-Sendon J, Garcia E, Perez de Isla L, Lopez de Sa E, Ortega A, Moreno M, Rubio R, Soriano J, Abeytua M, Garcia-Fernandez MA. | title=Primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction. | journal=J Am Coll Cardiol | year=2002 | volume=39 | issue=4 | pages=598-603 | id=PMID 11849857}}</ref> The incidence of myocardial rupture if PCI is performed in the setting of an acute myocardial infarction is about 1 percent.<ref name="Yip-2003">{{cite journal | author=Yip HK, Wu CJ, Chang HW, Wang CP, Cheng CI, Chua S, Chen MC. | title=Cardiac rupture complicating acute myocardial infarction in the direct percutaneous coronary intervention reperfusion era. | journal=Chest | year=2003 | volume=124 | issue=2 | pages=565-71 | format=PDF | url=http://www.chestjournal.org/cgi/reprint/124/2/565.pdf | id=PMID 12907544}}</ref>
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| ==Pathophysiology== | | ==[[Myocardial rupture pathophysiology|Pathophysiology]]== |
| The most common cause of myocardial rupture is a recent myocardial infarction, with the rupture typically occurring three to five days after infarction. Other causes of rupture include cardiac trauma, [[endocarditis]] (infection of the heart),<ref name="Lin-2006">{{cite journal | author=Lin TH, Su HM, Voon WC, Lai HM, Yen HW, Lai WT, Sheu SH. | title=Association between hypertension and primary mitral chordae tendinae rupture. | journal=Am J Hypertens | year=2006 | volume=19 | issue=1 | pages=75-9 | id=PMID 16461195}}</ref><ref name="de Diego-2006">{{cite journal | author=de Diego C, Marcos-Alberca P, Pai RK. | title=Giant periprosthetic vegetation associated with pseudoaneurysmal-like rupture. | journal=Eur Heart J | year=2006 | volume=27 | issue=8 | pages=912 | format=PDF | url=http://eurheartj.oxfordjournals.org/cgi/reprint/27/8/912.pdf | id=PMID 16569654}}</ref> [[cardiac tumor]]s, infiltrative diseases of the heart,<ref name="Lin-2006"/> and [[aortic dissection]].
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| ==Risk Factors for Myocardial Rupture== | | ==[[Myocardial rupture causes|Causes]]== |
| Risk factors for rupture after an acute myocardial infarction include female gender,<ref name="Yip-2003"/><ref name="Moreno-2002"/> advanced age of the individual,<ref name="Yip-2003"/><ref name="Moreno-2002"/> and a low [[body mass index]].<ref name="Yip-2003"/> Other presenting signs associated with myocardial rupture include a pericardial friction rub, sluggish flow in the coronary artery after it is opened, the [[left anterior descending artery]] being the cause of the acute MI,<ref name="Yip-2003"/><ref name="Moreno-2002"/><ref name="Sugiura-2003">{{cite journal | author=Sugiura T, Nagahama Y, Nakamura S, Kudo Y, Yamasaki F, Iwasaka T. | title=Left ventricular free wall rupture after reperfusion therapy for acute myocardial infarction. | journal=Am J Cardiol | year=2003 | volume=92 | issue=3 | pages=282-4 | id=PMID 12888132}}</ref> and delay of revascularization greater than 2 hours.<ref name="Moreno-2002"/>
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| ==Classification== | | ==[[Myocardial rupture epidemiology and demographics|Epidemiology and Demographics]]== |
| Myocardial ruptures can be classified as one of three types. | |
| ===Type I===
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| An abrupt slit-like tear that generally occurs within 24 hours of an acute myocardial infarction. Type II is an erosion of the infarcted myocardium, which is suggestive of a slow tear of the dead myocardium. Type II ruptures typically occur more than 24 hours after the infarction occurred. Type III ruptures are characterized by early aneurysm formation and subsequent rupture of the aneurysm.<ref name="Becker-1975">{{cite journal | author=Becker AE, van Mantgem JP. | title=Cardiac tamponade. A study of 50 hearts. | journal=Eur J Cardiol | year=1975 | volume=3 | issue=4 | pages=349-58 | id=PMID 1193118}}</ref>
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| Another method for classifying myocardial ruptures is by the anatomical portion of the heart that has ruptured. By far the most dramatic is rupture of the free wall of the left of right ventricles, as this is associated with immediate hemodynamic collapse and death secondary to acute [[pericardial tamponade]]. Rupture of the interventricular septum will cause a [[ventricular septal defect]]. Rupture of a papillary muscle will cause acute [[mitral regurgitation]].
| | ==[[Myocardial rupture risk factors|Risk Factors]]== |
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| ==Signs and symptoms== | | ==[[Myocardial rupture as a cause of sudden cardiac death following STEMI|Relative Contribution of Myocardial Rupture as a Cause of Sudden Cardiac Death Following STEMI]]== |
| Symptoms of myocardial rupture are recurrent or persistent [[chest pain]], [[syncope]], and distension of [[jugular vein]]s.
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| | ==[[Myocardial rupture natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| Due to the acute hemodynamic deterioration associated with myocardial rupture, the diagnosis is generally made based on physical examination, changes in the vital signs, and clinical suspicion. The diagnosis can be confirmed with [[echocardiography]].
| | [[Myocardial rupture history and symptoms|History and Symptoms]] | [[Myocardial rupture physical examination|Physical Examination]] | [[Myocardial rupture echocardiography|Echocardiography]] | [[Myocardial rupture other imaging findings|Other Imaging Findings]] | [[Myocardial rupture other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
| The treatment for myocardial rupture is supportive in the immediate setting and surgical correction of the rupture, if feasible. A certain small percentage of individuals do not seek medical attention in the acute setting and survive to see the physician days or weeks later. In this setting, it may be reasonable to treat the rupture medically and delay or avoid surgery completely, depending on the individual's [[comorbidity|comorbid]] medical issues.
| | [[Myocardial rupture medical therapy|Medical Therapy]] | [[Myocardial rupture surgery|Surgery]] | [[Myocardial rupture ACC/AHA guideline recommendations|ACC/AHA Guideline Recommendations]] | [[Myocardial rupture primary prevention|Primary Prevention]] | [[Myocardial rupture secondary prevention|Secondary Prevention]] | [[Myocardial rupture cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Myocardial rupture future or investigational therapies|Future or Investigational Therapies]] |
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| ==Prognosis==
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| The prognosis of myocardial rupture is dependant on a number of factors, including which portion of the myocardium is involved in the rupture. In one case series, if myocardial rupture involved the free wall of the [[left ventricle]], the mortality rate was 100 percent.<ref name="Yip-2003"/> Even if the individual survives the initial hemodynamic sequelae of the rupture, the 30 day mortality is still significantly higher than if rupture did not occur.<ref name="Yip-2003"/>
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| ==Pathological Findings==
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| [http://www.peir.net Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
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| <div align="left">
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| <gallery heights="225" widths="225">
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| Image:Myocardial rupture 1.jpg|Myocardial rupture
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| Image:Myocardial rupture 2.jpg|Myocardial rupture
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="225" widths="225">
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| Image:Myocardial rupture 3.jpg|Myocardial rupture
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| Image:Myocardial rupture 4.jpg|Myocardial rupture
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="225" widths="225">
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| Image:Myocardial rupture 5.jpg|Myocardial rupture
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| Image:Myocardial rupture 6.jpg|Myocardial rupture
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="225" widths="225">
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| Image:Myocardial rupture 7.jpg|Myocardial rupture: Gun shot
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| </gallery>
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| </div>
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| ==References==
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| {{Reflist|2}}
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| | == Case Studies == |
| | [[Myocardial rupture case study one|Case #1]] |
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| {{chest trauma}} | | {{chest trauma}} |
| {{SIB}}
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| | [[Category:Disease]] |
| | [[Category:Cardiology]] |
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| [[Category:Cardiology]] | | [[Category:Ischemic heart diseases]] |
| | [[Category:Emergency medicine]] |
| | [[Category:Intensive care medicine]] |
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