Myocardial rupture - Revision history

ClaireLewis at 16:01, 15 August 2019

2019-08-15T16:01:10Z

← Older revision		Revision as of 16:01, 15 August 2019
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	**Rupture in the setting of MI is nearly 100% fatal<ref>Beck RC, et al. Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists. Thrombolysis. 1999; 33(2):479-487.</ref>		**Rupture in the setting of MI is nearly 100% fatal<ref>Beck RC, et al. Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists. Thrombolysis. 1999; 33(2):479-487.</ref>

	*Blunt or penetrating trauma		*Blunt or penetrating [[cardiac trauma]]
	**Penetrating trauma tends to affect RV most often <ref>Jin-mou Gao MD, et al. Penetrating cardiac wounds: Principles for surgical management. World Journal of Surgery. 2004; 28(10)1025-1029.</ref>		**Penetrating trauma tends to affect RV most often <ref>Jin-mou Gao MD, et al. Penetrating cardiac wounds: Principles for surgical management. World Journal of Surgery. 2004; 28(10)1025-1029.</ref>
	***RV 43%		***RV 43%
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	*Infection (rare)		*Infection (rare)
	**Endocarditis and myocardial necrosis<ref>Qizilbash AH and Schwartz CJ. False aneurysm of left ventricle due to perforation of mitral-aortic intervalvular fibrosa with rupture and cardiac tamponade: Rare complication of infective endocarditis. 1973; 32(1) :110-113.</ref>		**[[Endocarditis]] and myocardial necrosis<ref>Qizilbash AH and Schwartz CJ. False aneurysm of left ventricle due to perforation of mitral-aortic intervalvular fibrosa with rupture and cardiac tamponade: Rare complication of infective endocarditis. 1973; 32(1) :110-113.</ref>

	*Iatrogenic		*Iatrogenic
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	==Clinical Features==		==Clinical Features==
	*[[Chest pain]]		*[[Chest pain]]
	*Shortness of breath		*[[Shortness of breath]]
	*Obvious chest injury		*Obvious chest injury
	*Hypotension		*[[Hypotension]]
	*JVD		*JVD
	*Muffled heart sounds or rub		*Muffled heart sounds or rub
	*New murmur (heard best at apex, may be confused for mitral regurgitation)		*New [[murmur]] (heard best at apex, may be confused for mitral regurgitation)

	==Differential Diagnosis==		==Differential Diagnosis==
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	*[[Cardiac ultrasound\|Ultrasound]]		*[[Cardiac ultrasound\|Ultrasound]]
	**[[Pericardial effusion]]		**[[Pericardial effusion]]
	**Tamponade physiology (e.g. RV diastolic collapse)		**[[Tamponade]] physiology (e.g. RV diastolic collapse)
	**Doppler interrogation across the mitral valve will demonstrate exaggerated respiratory variability of transvalvular flow (due to the phenomenon of ventricular interdependence)		**Doppler interrogation across the mitral valve will demonstrate exaggerated respiratory variability of transvalvular flow (due to the phenomenon of ventricular interdependence)
	*[[ECG]]		*[[ECG]]

SLuckettG: /* Evaluation */

2019-03-12T01:33:35Z

Evaluation

← Older revision		Revision as of 01:33, 12 March 2019
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	**Tachycardia (bradycardia is ominous finding)		**Tachycardia (bradycardia is ominous finding)
	**Normal or low voltage		**Normal or low voltage
	**Electrical alternans~~, low~~ voltage QRS		**Electrical alternans
			**Low voltage QRS
	*[[CXR]]		*[[CXR]]
	**Enlarged cardiac silhouette		**Enlarged cardiac silhouette

SLuckettG: /* Clinical Features */

2019-03-12T01:33:01Z

Clinical Features

← Older revision		Revision as of 01:33, 12 March 2019
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	==Clinical Features==		==Clinical Features==
	*[[Chest pain]]~~, shortness~~ of breath		*[[Chest pain]]
			*Shortness of breath
	*Obvious chest injury		*Obvious chest injury
	*Hypotension		*Hypotension

SLuckettG: /* Background */

2019-03-12T01:32:38Z

Background

← Older revision		Revision as of 01:32, 12 March 2019
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	==Background==		==Background==
	*~~Rupture includes defects~~ in ~~the~~ atria, ventricles, or junctions of major vessels		*Defects in atria, ventricles, or junctions of major vessels

	===Etiology===		===Etiology===
	*[[Myocardial infarction]] ~~– “Softening”~~ of myocardium<ref>Beck RC, et al. Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists. Thrombolysis. 1999; 33(2):479-487.</ref>		*[[Myocardial infarction]] causes “softening” of myocardium<ref>Beck RC, et al. Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists. Thrombolysis. 1999; 33(2):479-487.</ref>
	**1.7% of MI patients		**Complication seen in 1.7% of MI patients
	**Typically ~~occurs~~ 24-48h post-MI ~~(can be 3-5d if MI was untreated)~~ but can occur ~~within~~ two weeks		**Typically 24-48h post-MI but can occur up to two weeks post-MI
	**Rupture in the setting of MI is nearly 100% fatal<ref>Beck RC, et al. Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists. Thrombolysis. 1999; 33(2):479-487.</ref>		**Rupture in the setting of MI is nearly 100% fatal<ref>Beck RC, et al. Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists. Thrombolysis. 1999; 33(2):479-487.</ref>

	*~~Trauma – blunt and~~ penetrating trauma		*Blunt or penetrating trauma
	**Penetrating trauma tends to affect RV		**Penetrating trauma tends to affect RV most often <ref>Jin-mou Gao MD, et al. Penetrating cardiac wounds: Principles for surgical management. World Journal of Surgery. 2004; 28(10)1025-1029.</ref>
	**RV 43%, LV 23%, RA 13%, LA 11%, Pericardium alone 10%<ref>Jin-mou Gao MD, et al. Penetrating cardiac wounds: Principles for surgical management. World Journal of Surgery. 2004; 28(10)1025-1029.</ref>		***RV 43%
			***LV 23%
			***RA 13%
			***LA 11%
			**Pericardium only 10%

	*Infection – Endocarditis and myocardial necrosis<ref>Qizilbash AH and Schwartz CJ. False aneurysm of left ventricle due to perforation of mitral-aortic intervalvular fibrosa with rupture and cardiac tamponade: Rare complication of infective endocarditis. 1973; 32(1) :110-113.</ref>		*Infection (rare)
	**Rare		**Endocarditis and myocardial necrosis<ref>Qizilbash AH and Schwartz CJ. False aneurysm of left ventricle due to perforation of mitral-aortic intervalvular fibrosa with rupture and cardiac tamponade: Rare complication of infective endocarditis. 1973; 32(1) :110-113.</ref>

	*Iatrogenic – Pacer wire placement<ref>Trigano JA, et al. Heart perforation following transvenous implantation of a cardiac pacemaker. Presse Med. 1999; 28:836–40.</ref>		*Iatrogenic
	**Tend to be small perforations ~~which rarely lead to tamponade or~~ hemodynamic ~~consequences~~		**Pacer wire placement<ref>Trigano JA, et al. Heart perforation following transvenous implantation of a cardiac pacemaker. Presse Med. 1999; 28:836–40.</ref>
			***Tend to be small perforations
			***Tamponade and hemodynamic instability are rare

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Workup */

2018-11-20T22:57:43Z

Workup

← Older revision		Revision as of 22:57, 20 November 2018
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	{{Template:Chest Pain DDX}}		{{Template:Chest Pain DDX}}

	==~~Workup~~==		==Evaluation==
	*[[Cardiac ultrasound\|Ultrasound]]		*[[Cardiac ultrasound\|Ultrasound]]
	**Pericardial effusion		**[[Pericardial effusion]]
	**Tamponade physiology (e.g. RV diastolic collapse)		**Tamponade physiology (e.g. RV diastolic collapse)
	**Doppler interrogation across the mitral valve will demonstrate exaggerated respiratory variability of transvalvular flow (due to the phenomenon of ventricular interdependence)		**Doppler interrogation across the mitral valve will demonstrate exaggerated respiratory variability of transvalvular flow (due to the phenomenon of ventricular interdependence)
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	*[[CXR]]		*[[CXR]]
	**Enlarged cardiac silhouette		**Enlarged cardiac silhouette
	*[[Pulsus ~~Paradoxus~~]]		*[[Pulsus paradoxus]]
	**>10mmHg change in systolic BP on inspiration		**>10mmHg change in systolic BP on inspiration
	*Direct visualization on thoracotomy (if indicated)		*Direct visualization on thoracotomy (if indicated)

Sabedi: /* Clinical Features */

2018-10-22T01:56:02Z

Clinical Features

← Older revision		Revision as of 01:56, 22 October 2018
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	*Hypotension		*Hypotension
	*JVD		*JVD
	*Muffled heart sounds or ~~new~~ murmur ~~or rub~~		*Muffled heart sounds or rub
			*New murmur (heard best at apex, may be confused for mitral regurgitation)

	==Differential Diagnosis==		==Differential Diagnosis==

Sabedi: /* Etiology */

2018-10-22T01:50:29Z

Etiology

← Older revision		Revision as of 01:50, 22 October 2018
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	*[[Myocardial infarction]] – “Softening” of myocardium<ref>Beck RC, et al. Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists. Thrombolysis. 1999; 33(2):479-487.</ref>		*[[Myocardial infarction]] – “Softening” of myocardium<ref>Beck RC, et al. Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists. Thrombolysis. 1999; 33(2):479-487.</ref>
	**1.7% of MI patients		**1.7% of MI patients
	**Typically occurs 24-48h post-MI (can be 3-5d if MI was untreated)		**Typically occurs 24-48h post-MI (can be 3-5d if MI was untreated) but can occur within two weeks
	**Rupture in the setting of MI is nearly 100% fatal<ref>Beck RC, et al. Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists. Thrombolysis. 1999; 33(2):479-487.</ref>		**Rupture in the setting of MI is nearly 100% fatal<ref>Beck RC, et al. Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists. Thrombolysis. 1999; 33(2):479-487.</ref>

Neil.m.young: Text replacement - "Ultrasound: Cardiac" to "Cardiac ultrasound"

2017-03-04T14:11:25Z

Text replacement - "Ultrasound: Cardiac" to "Cardiac ultrasound"

← Older revision		Revision as of 14:11, 4 March 2017
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	==Workup==		==Workup==
	*[[~~Ultrasound:~~ Cardiac\|Ultrasound]]		*[[Cardiac ultrasound\|Ultrasound]]
	**Pericardial effusion		**Pericardial effusion
	**Tamponade physiology (e.g. RV diastolic collapse)		**Tamponade physiology (e.g. RV diastolic collapse)

Rossdonaldson1: Text replacement - "Chest pain" to "Chest pain"

2016-09-25T22:22:23Z

Text replacement - "*Chest pain" to "*Chest pain"

← Older revision		Revision as of 22:22, 25 September 2016
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	==Clinical Features==		==Clinical Features==
	*Chest pain, shortness of breath		*[[Chest pain]], shortness of breath
	*Obvious chest injury		*Obvious chest injury
	*Hypotension		*Hypotension

Rossdonaldson1: Text replacement - "MI " to "Myocardial infarction "

2016-09-24T17:45:24Z

Text replacement - "*MI " to "*Myocardial infarction "

← Older revision		Revision as of 17:45, 24 September 2016
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	===Etiology===		===Etiology===
	*MI – “Softening” of myocardium<ref>Beck RC, et al. Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists. Thrombolysis. 1999; 33(2):479-487.</ref>		*[[Myocardial infarction]] – “Softening” of myocardium<ref>Beck RC, et al. Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists. Thrombolysis. 1999; 33(2):479-487.</ref>
	**1.7% of MI patients		**1.7% of MI patients
	**Typically occurs 24-48h post-MI (can be 3-5d if MI was untreated)		**Typically occurs 24-48h post-MI (can be 3-5d if MI was untreated)