Cardiac Rupture in Acute Myocardial Infarction

Abstract

ABSTRACT. The occurrence of rupture of the external cardiac wall (CR) in a consecutive series of 2 244 admissions with confirmed acute myocardial infarction (AMI) has been analysed. The series comprises the unselected admissions to a single department, evaluated according to uniform criteria, with postmortem examination in 95% of fatal cases. The incidence of CR was 3.2% af all cases of AMI, and 12.6% of all deaths. CR was significantly more frequent in women than in men, and in both sexes significantly more frequent after the age of 60, though the age distribution did not differ significantly from that of the patients dying from other causes. Moreover, CR was significantly more frequent in anterior wall infarctions, and in patients with no previous AMI. The majority of CR (84%) occurred within the first week, and a considerable part (32%) within the first 24 hours after the onset of infarction. According to findings at autopsy, CR was accompanied particularly often (in 71%) by complete occlusion of a major coronary artery. Autopsy findings gave no evidence that attempts at resuscitation, including external cardiac massage (65 patients), as well as intracardial injections (55 patients) and transthoracic introduction of a pace catheter (3 patients), could have any connection with the development of CR. The usual strict immobilization of the patients was applied during the first part of the series, but in the latter half (1 337 admissions) the patients were allowed to be out of bed from the first day with no imposed immobilization at all. The incidence of CR did not change significantly throughout the period, and the indication for maintaining the traditional immobilization of patients with AMI is questioned.