Document Detail

Free-wall rupture of the myocardium following infarction: a changing clinical portrait in the reperfusion era: a case report.
MedLine Citation:
PMID:  17067988     Owner:  NLM     Status:  MEDLINE    
Free wall rupture of the myocardium is an important complication and major cause of death following acute transmural (ST segment elevation) myocardial infarction. Pathologic changes on a cellular level may combine with mechanical stressors to weaken the myocardium postinfarction. Risk factors for myocardial rupture include advanced age, female gender, prior hyper-tension, first myocardial infarction, late presentation, lack of collateral blood flow, and persisting chest pain and ST segment elevations. Thrombolytic therapy does not increase risk of rupture when given early in myocardial infarction, but late thrombolytic therapy may heighten risk. Primary percutaneous coronary intervention for acute myocardial infarction has reduced the incidence of myocardial rupture compared to thrombolytic therapy. This advantage likely can be ascribed to higher rates of immediate reperfusion with catheter techniques, as well as to the avoidance of thrombolytic-mediated hemorrhagic transformation of the infarction zone. Careful regulation of blood pressure and pulse using nitrates and beta-adrenergic blockers may mitigate the tendency toward myocardial rupture. Early and accurate diagnosis based on clinical and echocardiographic evidence can lead to successful surgical treatment.
Gaby Weissman; Christopher C Kwon; Richard K Shaw; John F Setaro
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Angiology     Volume:  57     ISSN:  0003-3197     ISO Abbreviation:  Angiology     Publication Date:    2006 Oct-Nov
Date Detail:
Created Date:  2006-10-27     Completed Date:  2006-11-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0203706     Medline TA:  Angiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  636-42     Citation Subset:  IM    
Section of Cardiovascular Medicine, Yale University School of Medicine and Cardiothoracic Surgery, New Haven, CT, USA.
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MeSH Terms
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary
Heart Rupture, Post-Infarction* / pathology,  physiopathology,  therapy
Myocardium / pathology
Thrombolytic Therapy

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