Rupture of Heart Complicating Myocardial Infarction

Analysis of 40 Cases including Nine Examples of Left Ventricular False Aneurysm

¹ Department of Pathology, The Charles T. Miller Hospital, St. Paul, and the Departments of Pathology and Medicine, University of Minnesota, Minneapolis

Forty heart specimens demonstrating cardiac rupture complicating acute myocardial infarction were reviewed. Twenty-seven men with a mean age of 64.1 years and 13 women with a mean age of 71.7 years composed the population of this series. All anatomic regions of the left ventricle were equally involved in cardiac rupture. Twenty-eight specimens showed rupture of the free wall of the left ventricle; nine of these 28 cases developed a false aneurysm. The nine cases of false aneurysm were complicated by rupture of the false aneurysm in four. Two of the nine patients with formation of a false aneurysm had successful surgical resection of the aneurysm. Five cases of rupture of the free wall of the left ventricle revealed a significant time discrepancy between the onset of the clinical symptoms of the acute myocardial infarction and the histologic age of the myocardial infarction at autopsy. In each case, the histologic age revealed an older infarct than the clinical symptoms would suggest. This is interpreted to suggest that the myocardial infarction per se was undetected and that the symptoms erroneously attributed to acute myocardial infarction were secondary to cardiac rupture. Fifteen specimens showed rupture of an intracardiac structure, eight revealed rupture of the ventricular septum and seven showed rupture of a papillary muscle. Prompt clinical detection of cardiac rupture is stressed with a goal of surgical intervention in selected patients.