Document Detail

Subacute left ventricular free-wall rupture in early course of acute myocardial infarction. Clinical report of two cases and review of the literature.
MedLine Citation:
PMID:  10088074     Owner:  NLM     Status:  MEDLINE    
Left ventricular free wall rupture (LVFWR) may complicate an acute myocardial infarction (AMI); its frequency ranges from 1 to 6 percent. In the era of coronary care units, LVFWR is the second cause of in-hospital death, after pump failure. The subacute presentation accounts for 2-3 percent of total hospital admissions for AMI. Heart rupture may not be suddenly fatal and sometimes there is enough time for surgical repair. Electromechanical dissociation is neither the only nor the main clinical presentation. More subtle symptoms occurring hours or days before the final event include unexplained hypotension and transient bradycardia and some ECG features such as persistent ST-segment elevation with T-waves failing to invert in the same leads. On echocardiographic subcostal view, pericardial effusion of more than 5-10 mm, with echo-dense masses overlying the heart independently of cardiac tamponade, is highly suggestive of heart rupture. If pericardiocentesis yields hemorrhagic fluid, surgical intervention is mandatory, providing both diagnostic confirmation and definitive treatment. Medical management strategies (prolonged bed rest, beta-blockade therapy) are still experimental but could become suitable for particular subsets of patients (elderly patients and patients at a high surgical risk). We report two cases of subacute LVFWR and review the currently available literature.
F Varbella; S Bongioanni; A Sibona Masi; E Iazzolino; G Alunni; M R Conte; A Brusca
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Giornale italiano di cardiologia     Volume:  29     ISSN:  0046-5968     ISO Abbreviation:  G Ital Cardiol     Publication Date:  1999 Feb 
Date Detail:
Created Date:  1999-04-13     Completed Date:  1999-04-13     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  1270331     Medline TA:  G Ital Cardiol     Country:  ITALY    
Other Details:
Languages:  eng     Pagination:  163-70     Citation Subset:  IM    
Cardiologia, Ospedale degli Infermi, Rivoli.
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MeSH Terms
Cardiac Tamponade / diagnosis,  surgery
Coronary Angiography
Fatal Outcome
Heart Rupture, Post-Infarction / diagnosis*,  surgery
Heart Ventricles

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