Acute myocardial infarction with rupture of the ventricle

Abstract

Although rupture of the heart has been known as a clinical entity for 3 centuries, it has come into prominence only with a better understanding of myocardial infarction. Harvey is said to have described the entity in 1647. 1 In 1765, Morgagni reported 11 cases of rupture of the heart, 1 and he placed the cause of rupture on marked fatty myocardial changes. It is interesting that Morgagni himself died of a ruptured heart. 2 Marie, in 1896, was the first to connect correctly coronary artery disease with myocardial infarction. This clinical entity is not at all rare. Krumbhaar and Crowell reviewed the literature in 1925 and found a total of 654 cases. 3 They added 22 cases of their own. An incidence of 9.5 per cent was reported in a series of 105 cases of acute myocardial infarction by Friedman and White. 4 These authors also cited the statistics of Mortlan, who found 42 cases of ruptured heart in a series of 2,000 instances of sudden death. Turnbull and Howell reported 8 cases over a 6 year period. 5 Diaz-Rivera and Miller presented a series of 5 ruptured hearts out of a total of 147 cases of myocardial infarction. 6 all five cases occurred in a group of 53 recent infarctions. In 94 old infarctions of that same series, there were no instances of rupture of the heart. The consensus of the literature places the incidence at approximately 9 per cent in acute myocardial infarction. Jetter and White reported a higher incidence in patients in a mental institution. 7 In their 22 cases there were 16 instances of rupture, an incidence of 73 per cent. The authors stated that in no case was an antemortem diagnosis of myocardial infarction made. We have observed 6 cases of rupture of the ventricle following acute myocardial infarction at The Toledo Hospital. It is the purpose of this paper to present and discuss these cases from the etiologic, pathologic, and diagnostic viewpoints, including a review of the recent literature.