[Heart rupture in acute myocardial infarct: the advantages of using M-2D color Doppler echocardiography in a coronary intensive therapy unit].
BACKGROUND
Free-wall rupture of the heart is the second most common cause of death in acute myocardial infarction (AMI), following pump failure. Acute rupture is more common and rapidly fatal, while subacute rupture, which accounts for about 30% of total cases of mortality in AMI, can be diagnosed early by clinical signs with the support of echocardiography in coronary intensive care units.


METHODS
From March 1996 to December 1997, 293 patients diagnosed with acute myocardial infarction were admitted to the coronary intensive care unit of our hospital. Of these patients, 71 (23.8%) were treated with thrombolysis within 6 hours of onset of symptoms. All patients were observed daily with M-2D color Doppler echocardiography and in the event of renewed chest pain, electrocardiogram changes, abrupt hypotension, syncope or clinical signs of low output syndrome.


RESULTS
We observed 11 cases (3.8%) of free-wall rupture of the heart in acute myocardial infarction with echocardiography, 6 females and 5 males, with a mean age of 74.2 +/- 7.8 years (min. 56-max 84), none of whom had prior AMI. Six of them received thrombolytic therapy, six were hypertensive (54.5%) and three were diabetics (27.2%). Surgical repair was performed in two patients with subacute rupture, but one died a few days later. The echocardiography data at bedside for diagnosis of cardiac rupture were confirmed in 5 patients with autopsy and intraoperatively in two of them.


CONCLUSIONS
Routine use of echocardiography in coronary intensive care units allows prompt diagnosis of cardiac rupture in acute myocardial infarction, and in the event of subacute rupture it can accelerate surgical decision-making.
Divisione di Cardiologia, UCIC, Ospedale Cazzavillan, Arzignano, VI.
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C
Perrone
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Pasquetto
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Boschello
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P
Dovigo
M C
MC
Marchiori
A
A
Galassi
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E
De Dominicis
D000368:Aged; D003325:Coronary Care Units; D003422:Critical Care; D004452:Echocardiography / Q000379:methods*; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006342:Heart Rupture, Post-Infarction / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011994:Recombinant Proteins / Q000627:therapeutic use; D013300:Streptokinase / Q000008:administration & dosage; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D013300:Streptokinase; D010959:Tissue Plasminogen Activator
Rottura di cuore nell'infarto acuto del miocardio: vantaggi dell'uso dell'ecocardiografia M-2D color Doppler in unità di terapia intensiva coronarica.