Studies of myocardial rupture with cardiac tamponade in acute myocardial infarction. I. Clinical features.

The clinical features of cardiac rupture with tamponade in acute myocardial in-farction have been studied in an attempt to predict this complication and find clues to prophylactic and therapeutic measures. Eleven cases with rupture of the free left ventricular wall in a consecutive series of 529 coronary care unit (CCU) patients with acute myocardial infarction have been analyzed. These 11 patients accounted for 10 percent of the mortality. The significant features were absence of a history of previous myocardial infarction in association with electro-cardiographic (ECG) signs of acute infarction present at time of admission. In no instance was the infarct purely inferior in its location. These characteristics would have given 0.2 percent false negative and 17 percent false positive prediction among these 529 patients with acute myocardial infarction. In seven of the patients the rupture occurred during the first day of the illness. In no case did the rupture occur in massive infarction, which provides a basis for hope of success following surgical intervention in the future. n 1859 Slalmstcn, then the professor of medicine I at Ser~ifimrrlieiirettet, sa\v a patient with severe central chest pain.' The patient died one week after onset of symptoms and autopsy showed what hlalmsten refers to as "a broken heart." It thus seems that it is more than 100 years ago that a physician fro111 this hospital sa\v a case of rupture of the left ventricle caused by an acute myocardial infarction. \\'ith the introduction of a coronary care unit (C C U) in this hospital interest has again been focused on this complic ' 1 t' lon. Coronary care units have lowered the hospital mortality in acute myocardial infarction to about 15 to 20 percent, mainly by reducing the number of deaths from the arrhythmias.' About half of the remaining mortality seems to be largely unprevent-able, as the infarcts coultl be shown at autopsy to involve more of the left ventricular mvocardium than is ever seen in the fibrotic stage of healing." This leaves about half of the mortality as potentiallv .-preventable. All cuscs of myocardial rupture with tiimponade are found in this half and account for al>out 20 percent of this g r o u p. T h u s rupture with tamponade is not unimportant among the 1)otc.n-tially pre\.entable causes of death in the ncutcb phase of myocardial infarction. It is thercforc of intercst to study the clinical characteristics of these. …