Atrial Rupture of the Heart

ATRIAL rupture of the heart is a dramatic event which leads inevitably to death. This paper reports the only case of atrial rupture among 5,900 autopsies at the Albany Hospital and summarizes the pertinent literature on atrial rupture as to etiology, diagnosis, pathologic physiology, sex, age, and treatment. A total of 79 cases of atrial rupture has been collected from the literature, classified and studied. The present report brings the total number of recorded instances of rupture of the atrium up to 80. The term "atrial rupture" denotes a complete, acquired defect of the wall of either atrium through which the blood may leak into the pericardial sac and produce a fatal pericardial tamponade. This condition, never yet known to be diagnosed ante mortem, and suspected only once in 80 cases,20 is frequently confused with ventricular rupture. Ventricular rupture occurs in 8 to 10 per cent of patients who develop myocardial infarction4 with a high incidence among insane40 and hypertensive patients.22 Atrial rupture, by contrast, is a much rarer condition. In the 710 combined cases of spontaneous rupture of the heart reported by Krumbhaar and Crowella and by Davenport,'8 atrial rupture occurred in 51 patients. The right atrium was involved in 38 patients and the left in 13. Bright and Beck," in a review of 152 cases of traumatic heart rupture, found the right atrium damaged