[Heart rupture during myocardial infarction: the long-lasting challenge for the hospital cardiologist is close to the last battle].
Cardiac rupture is a catastrophic and generally unexpected (although not always unpredictable) complication of acute myocardial infarction, and still represents a challenge for the hospital cardiologist. In fact, diagnostic criteria are not available which allow us to detect in the individual patients an impending rupture. On the other hand the early diagnosis of the rupture, although possible if based on clinical and echocardiographic criteria, allows only a small number of the patients to survive, and cannot be considered as a satisfying solution for this clinical problem. Starting from these discouraging considerations, the finding is underscored that heart rupture only rarely occurs among patients treated with primary coronary angioplasty. Thus primary angioplasty (unlike systemic thrombolysis) seems to be able to prevent the postinfarction cardiac rupture. As a consequence, primary angioplasty should be considered instead systemic thrombolysis for the reperfusion treatment of patients with acute myocardial infarction and clinically at risk for cardiac rupture (i.e., those aged > 60 years and with ST-segment elevation at hospital admission).
Bartoletti
Angelo
A
Unità Operativa di Cardiologia, Nuovo Ospedale San Giovanni di Dio, Firenze. bartoletti@dada.it
D002309:Cardiology; D006342:Heart Rupture, Post-Infarction / Q000628:therapy*; D006761:Hospitals; D006801:Humans
Rottura di cuore in corso di infarto miocardico: una lunga sfida per il cardiologo ospedaliero ormai prossima allo scontro finale.