Subacute Rupture of the Free Left Ventricular Wall Following Acute Myocardial Infarction

ABSTRACT. In previously published cases of subacute or sealed postinfarction rupture of the free left ventricular wall, the patients presented a clinical picture of sudden shock and tamponade. Our patient, a 64-year-old man, suffered renewed chest pain on the fourth postinfarction day and went into cardiogenic shock, which was pharmacologically reversible. There were no bed-side signs of tamponade and the ECG showed the pattern of acute pericarditis, both features in contrast to previously reported cases in the literature. Echocardiography demonstrated localized fluid in the pericardial sac and a puncture revealed non-coagulating blood. The patient was successfully operated on. At surgery a small rupture sealed by blood clots was demonstrated in the infarcted inferior wall of the left ventricle.     

Quantification of Left Ventricular Wall Dysfunction by M-Mode Echocardiographic Mapping in Heart Failure Following Acute Myocardial Infarction

ABSTRACT Echocardiographic mapping was performed in 44 patients on arrival in hospital and day 2 following acute myocardial infarction (AMI). To evaluate left ventricular (LV) function the per cent deviation of the mean systolic wall velocity (PD-V) from the normal was measured from 16 LV segments. Adequate data were obtained from 89% of the segments. The number of hypokinetic segments was somewhat higher in anterior than inferior AMI, reaching significance (p<0.05) on day 2. Dyskinetic segments were also more common in patients with anterior infarction (p<0.001), who also had significantly higher enzyme maxima than patients with inferior AMI (p<0.01). Enzyme maxima correlated well with the sum of PD-V from all hypokinetic segments on day 1 (r = 0.79, p<0.01). Compensatory hyperkinesia was more common in inferior than anterior AMI (p<0.001). Global LV function, estimated by subtracting the number of hyper- from hypokinetic segments (score σ S: Adj), was significantly related to heart failure (Killip classification) (p<0.01) and the respiratory rate (r = 0.71, p<0.01) in the acute phase as well as to heart failure during the first post AMI month (New York Heart Association classification).     

急性心肌梗死并发室间隔穿孔的研究及治疗进展

心肌再灌注疗法降低了急性心肌梗死并发室间隔穿孔的发病率 ,但是一旦发生穿孔 ,病人的恢复和存活仍然依赖于强有力的内科治疗和手术的介入。经皮穿刺介入封堵治疗作为治疗本病的一种新方法虽然尚存许多问题 ,但是其应用前景值得我们关注。     

Echocardiographic Diagnosis of Subacute Ventricular Wall Rupture Complicating Acute Myocardial Infarction

Rupture of ventricular wall is one of the most threatening complications of acute myocardial infarction. As a rule, it is rapidly lethal, and a precise diagnosis is seldom possible. On the contrary, in the so-called subacute ruptures (about one third of all cases), patients can survive for several hours, allowing time for diagnosis and immediate surgical intervention. We report here the case of one patient with subacute cardiac rupture who was diagnosed with echocardiography and successfully treated with pericardiocentesis and surgery.     

A Rare Clinical Entity: Ventricular Septal Rupture with Right Ventricular Wall Dissection after Inferior Myocardial Infarction

Right ventricular wall dissection following ventricular septal rupture related to inferior myocardial infarction has been reported in a few cases. In most of the cases, right ventricular wall dissection was diagnosed in postmortem studies. Herein, we present a 68-year-old man who had a ventricular septal rupture with right ventricular wall dissection after inferior myocardial infarction. Early recognition of this complication with bedside transthoracic echocardiography and prompt surgical repair are key to achieving survival in these patients.     

Ventricular Septal Rupture Complicating Silent Myocardial Infarction

A 55-year-old gentleman presented to the emergency department with shortness of breath for the past 3 days. Cardiac magnetic resonance imaging assessed intracardiac shunting and a mechanism of ventricular septal rupture (VSR), showing significant left-to-right shunting and Qp:Qs of 4:1. There was transmural myocardial infarction as well as an aneurysm at the diaphragmatic inferior wall of the left ventricle.     

Left Ventricular Rupture after Embolic Myocardial Infarction Due to Mitral Valve Endocarditis

We report a very rare case of a 43‐year‐old patient with fatal left ventricular subepicardial aneurysm rupture complicating embolic myocardial infarction due to mitral valve infective endocarditis.     

急性心肌梗死合并左心室血栓的研究现状

左心室血栓形成是急性心肌梗死严重的并发症之一,尤其在急性前壁心肌梗死中的发生率更高,栓子脱落后主要可使体循环动脉栓塞,可引起脑、脾和肾等重要脏器功能障碍及肢体功能障碍而产生严重后果.因此,如何预防、早期诊断左心室血栓形成及防治不良后果,在临床医疗有重要意义.现对急性心肌梗死合并左心室血栓形成的研究状况做一综述.     

Echocardiographic Features of Ventricular Septal Rupture with Right Ventricular Aneurysm After Acute Myocardial Infarction

Postinfarction ventricular septal defect is a life-threatening disorder that may be adequately treated if the diagnosis is obtained promptly. Two-dimensional color Doppler echocardiography is a reliable tool for this diagnosis and gives additional information regarding its location, size, and shape. The authors emphasize the feasibility of this method to depict a particular form of postinfarction interventricular septal rupture, which developed an aneurysm inside the right ventricular cavity. Its characteristics were completely defined by color Doppler echocardiography and confirmed at surgery.     

急性心肌梗死并发室间隔破裂的研究进展

急性心肌梗死后并发的室间隔破裂穿孔是一种少见但是非常严重的并发症，自然病程凶险。早期诊断、积极的内科治疗和外科手术可降低死亡率，改善预后。     

Transesophageal Color Doppler Echocardiographic Diagnosis of Cardiac Rupture Following Acute Myocardial Infarction

This report describes a case of cardiac rupture following acute myocardial infarction accurately diagnosed by transesophageal color Doppler echocardiography, which showed a very narrow transmural tract from the left ventricle into the pseudoaneurysm cavity. Such a small, slitlike rupture would most likely have been missed by an otherwise routine transesophageal examination, and we stress the importance of color Doppler interrogation in its accurate diagnosis.     

急性下壁心肌梗塞并左前分支传导阻滞的临床意义

将 70例首次发生下壁心肌梗塞 (下壁 AMI)的患者分为两组。 A组为 14例合并左前分支传导阻滞 ( LAH)者 ,B组为 56例单纯下壁 AMI者。比较两组患者住院期间心脏事件 (梗塞后心绞痛、再梗塞、充血性心力衰竭、心源性休克及死亡 )的发生率及出院前左室射血分数 ( LVEF)、室性心律失常( VA)发生率。结果显示 ,A组住院期间心脏事件发生率 ( 64.3% )明显高于 B组 ( 19.6% ) ,P<0 .0 1;出院前 LVEF[( 4 5.7± 12 .8) % ]明显低于 B组 [( 57.2± 9.6) % ],P<0 .0 1;VA发生率 ( 64.3% )明显高于B组 ( 2 5.0 % ) ,P<0 .0 5。提示下壁 AMI发生 L AH者近期预后不良 ,可能存在冠脉左前降支狭窄及多支病变     

Papillary Muscle Rupture as a First Event in Acute Myocardial Infarction

Abstract. Cardiogenic shock caused by papillary muscle rupture in acute myocardial infarction is potentially reversible by surgical treatment. A case of inferior myocardial infarction in a 56-year-old previously healthy man is reported, in which the first event was papillary muscle rupture. The patient was in shock and had a mitral insufficiency murmur. The diagnosis was made by echocardiography and ventriculography. A St. Jude valve was implanted, and the patient was discharged in good health. It is suggested that routine echocardiography be carried out on patients with sudden cardiogenic shock, when a mitral murmur is present.     

经皮冠状动脉介入治疗对急性心肌梗死患者左室重构的影响

经皮冠状动脉介入治疗能够有效防止左室重构 ,改善左室功能 ,但其作用机制和实行时机尚不明确。通过对其作用机制及实行时机的研究 ,为及时、有效实行PCI提供理论依据。     

Unusual Site of Left Ventricular Thrombus after Acute Myocardial Infarction

Left ventricular (LV) thrombus formation is a frequent complication in patients with acute anterior myocardial infarction (MI). Its incidence is lower with inferior wall MI. Risk factors for the development of LV thrombus are consistently irrespective of infarct treatment and include large infarct size, severe apical akinesia or dyskinesia LV aneurysm, and anterior MI.     

Repeated Low-dose of Erythropoietin is Associated with Improved Left Ventricular Function in Rat Acute Myocardial Infarction Model

Objective To evaluate the potential protective affects of Epo on left ventricular (LV) function and remodeling after acute myocardial infarction (MI). Methods Epo was injected into the peritoneum of male Wistar rats (250 g) during 6 weeks post induction of MI. Rats were divided into five groups: MI treated with single high dose (MT1, 5,000 U/kg, n = 10), single high dose (5,000 U/kg) and repeated high doses (MTHi, 1,000 U/kg twice a week; n = 8), or single high dose (5,000 U/kg) and repeated low doses (MTLo, 750 U/kg once a week, n = 10), MI non-treated (MNT, n = 10), sham (S, n = 5). Echocardiography was performed 3.6 ± 1.5 days and 43.7 ± 2.3 days post MI. Collagen deposition and infarct size were measured on histological sections using computerized image analysis. Apoptosis was assessed by ApopTag staining. Results Baseline fractional shortening (FS) was similar between groups. Six weeks after MI the FS of MTLo (26.9%) was significantly higher compared to MNT (17.8%), MT1 (19.5%) and MTH (22.3%) (p = 0.01). However, remodeling indices (end diastolic and end systolic areas, LV circumference) did not improve in the Epo groups, and even worsened in the MTHi group. There was significantly less collagen staining in non-infarct areas in MT1 and MTHi groups compared to MNT and MTLo (0.38 ± 0.3%, 0.49 ± 0.34%, vs 0.89 ± 0.41%, 0.95 ± 0.33%, respectively, p < 0.001). The number of ApopTag positive nucleus was significantly higher in the MNT group compared to the MT1, MTHi, MTLo groups (14.4 ± 8, 7.6 ± 4, 5.8 ± 7, 4.8 ± 5, respectively, p = 0.01 for trend). Conclusion Repeated low doses of Epo after MI improved LV function, but the role of Epo on remodeling is not clear. It did not reduce left ventricular indices, but reduces fibrosis and apoptosis. High Epo doses reduced LV function and aggravated remodeling.