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Harmony R. Reynolds, Judith S. Hochman, Heartbreak, European Heart Journal, Volume 31, Issue 12, June 2010, Pages 1433–1435, https://doi.org/10.1093/eurheartj/ehq089
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Extract
This editorial refers to ‘Factors related to heart rupture in acute coronary syndromes in the Global Registry of Acute Coronary Events’†, by J. López-Sendón et al., on page 1449
Myocardial rupture, the most devastating complication of acute coronary syndromes (ACS), was once fairly common (2–6%) but has become less so, owing in part to early reperfusion therapy for ST elevation myocardial infarction (STEMI) and probably also in part to a lower frequency of post-mortem examination in recent years.1–4 Mortality is very high, but when subacute rupture is promptly suspected and corrected, long-term survival can reach nearly 50%.2
The typical presentation of myocardial rupture is electromechanical dissociation, often preceded by nausea, vomiting, restlessness, pericardial pain, and abrupt bradycardia and/or hypotension, which may be transient in the case of rupture which is temporarily sealed by the pericardium. Rupture accounts for 95% of deaths due to electromechanical dissociation after myocardial infarction (MI).5 It is critical to keep this diagnosis in mind as one cares for patients with ACS, because early surgical repair can be lifesaving. Recent trainees in cardiology, in particular, may believe that they have seen very few cases and should be reminded of the clinical presentation and need for early diagnosis and treatment.
