title: Diverse presentations of cardiac rupture following acute myocardial infarction.
abstract: BACKGROUND
  Cardiac rupture is a rare but ominous complication of myocardial infarction.
  
  
  OBJECTIVE
  To study the clinical presentation, medical course, outcome and echocardiographic predictors of patients with myocardial rupture.
  
  
  METHODS
  We evaluated 15 consecutive patients with cardiac rupture during a 4 year period in our department. The current report explores the presence of potential risk factors, timing, relation to the thrombolysis, coronary interventions and outcome.
  
  
  RESULTS
  The index event in all patients was first ST elevation myocardial infarction. In seven patients rupture occurred in the first 24 hours. Pericardial effusion on admission with a clot was present in three patients. Five patients received thrombolytic therapy. Only three patients underwent coronary angioplasty, but in one case it was performed late and in two patients the culprit artery could not be opened. Six patients reached the operating room, of whom three survived.
  
  
  CONCLUSIONS
  The lack of early mechanical reperfusion in acute myocardial infarction and thrombolytic therapy are risk factors for cardiac rupture. Pericardial effusion on admission and evidence of a clot are echocardiographic indicators of cardiac rupture and should alert the medical team to further assess the possibility of cardiac rupture.
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Marina
authors.initials: M
authors.lastname: Leitman
authors.forename: Vladimir
authors.initials: V
authors.lastname: Shir
authors.forename: Eli
authors.initials: E
authors.lastname: Peleg
authors.forename: Simha
authors.initials: S
authors.lastname: Rosenblatt
authors.forename: Edgar
authors.initials: E
authors.lastname: Sucher
authors.forename: Ricardo
authors.initials: R
authors.lastname: Krakover
authors.forename: Edo
authors.initials: E
authors.lastname: Kaluski
authors.forename: Zvi
authors.initials: Z
authors.lastname: Vered
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology; D012008:Recurrence; D015912:Thrombolytic Therapy