Contrast echocardiography for detection of incomplete rupture of the left ventricle after acute myocardial infarction

Myocardial rupture is a major complication after acute myocardial infarction. With complete rupture of the free left ventricular wall cardiac tamponade occurs with fatal outcome in most cases. With partial rupture, however, hemorrhage is slower, allowing days or weeks for diagnosis. Survival of thes...

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Bibliographic Details
Published in:Zeitschrift für Kardiologie 2004-08, Vol.93 (8), p.624-629
Main Authors: Wilkenshoff, Ursula Maria, Ale Abaei, Angela, Kuersten, Bettina, Pauschinger, Matthias, Schwimmbeck, Peter, Hetzer, Roland, Schultheiss, Heinz-Peter
Format: Article
Language:ger
Subjects:
Echocardiography - methods
Echocardiography, Doppler
Follow-Up Studies
Heart Rupture - diagnostic imaging
Heart Rupture - surgery
Heart Ventricles
Humans
Male
Middle Aged
Myocardial Infarction - complications
Shock, Cardiogenic - etiology
Time Factors
Treatment Outcome
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Summary:Myocardial rupture is a major complication after acute myocardial infarction. With complete rupture of the free left ventricular wall cardiac tamponade occurs with fatal outcome in most cases. With partial rupture, however, hemorrhage is slower, allowing days or weeks for diagnosis. Survival of these patients strongly depends on early recognition of this complication followed by immediate surgical intervention. Echocardiography is the diagnostic tool of choice to detect myocardial rupture with consecutive hemopericardium but diagnosis remains difficult even if suspected. We describe the case of a patient with inferior infarction who presented with cardiogenic shock, echocardiographic signs of pericardial effusion and abnormal motion and myocardial irregularities of the inferior wall. With Doppler echocardiography no flow across the wall was detected. Left heart contrast echocardiography confirmed the diagnosis of suspected myocardial rupture by clear deliniation of the defect. Immediate surgical repair was successfully performed in this patient with favorable long-term outcome. Thus, echocardiography early after acute myocardial infarction is useful in detecting subsequent complications and the use of contrast echocardiography should be considered in suspected myocardial rupture.
ISSN:0300-5860
DOI:10.1007/s00392-004-0103-3