Heart Failure – Myocardial Rupture

Myocardial rupture or heart rupture refers to the laceration or tearing of the ventricular and auricular walls of the heart, of the interventricular and interatrial septum, of chordae tendineae , of the papillary muscles or of the valves of the heart. It is price one of the serious consequences of an acute myocardial infarction. It is commonly observed three to five days after MI. The usage of early revascularization and intensive pharmacotherapy for treating MI, led to the decrease in the incidence of myocardial rupture to about 1%  of all MIs. This rupture usually takes place in the free walls of the ventricles, the papillary muscles, the septum between ventricles, or the atria. Rupture results due to increased pressure against the weak walls of the heart chambers because the heart muscle cannot pump the blood out effectively.

The risk factors for myocardial rupture includes occurrence of Myocardial infarction with no revascularization, advanced age, female sex, and absence of a previous history of MI. Moreover, the risk of rupture is higher in those individuals who are revascularized with a thrombolytic agent as compared to PCI. The shear stress that present between the infarcted segment and the surrounding normal myocardium makes it a susceptible for rupture.

Myocardial Rupture is a disastrous event that may lead to cardiac tamponade, where blood accumulates within the pericardium and compresses the heart so that it cannot pump effectively.  The rupture of the intraventricular  septum leads to a ventricular  septal defect from where the blood passes from the left side to the right side of the heart leading to right ventricular failure and pulmonary overcirculation. Moreover, the rupture of the papillary muscle causes acute mitral regurgitation and consequent pulmonary oedema or even cardiogenic shock. The symptoms of myocardial rupture include the recurrent chest pain, syncope, and tightness of jugular veins.

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