Correspondence

Cardiac Rupture

N Engl J Med 2003; 348:2264May 29, 2003

Article

To the Editor:

In their Image in Clinical Medicine, Redfern and Smart (Feb. 13 issue)1 describe a case of cardiac rupture in a man who initially presented with atypical chest pain and electrocardiographic signs of myocardial infarction. During subsequent diagnostic radiologic procedures, cardiac arrest developed, and the patient died.

Recognition of subacute free-wall rupture is a challenging clinical problem. Some patients with cardiac rupture succumb almost instantaneously, with rapid electromechanical dissociation; others have a subacute presentation, with a slow or repetitive clinical course. In these patients, who may survive for several hours to days, early recognition allows potentially lifesaving interventions to be performed.

Myocardial rupture may be suspected on the basis of typical symptoms, such as recurrent or persistent chest pain and cardiogenic shock. However, rupture may also be recognized on the basis of electrocardiographic signs. We have recently shown that sinus tachycardia, ST-segment elevation in lead V₅, or both may be independent predictors of rupture after inferior myocardial infarction.2 On the basis of these criteria, patients with subacute rupture were identified with 75 percent sensitivity and 92 percent specificity. Precious time gained by the electrocardiographic diagnosis of cardiac rupture may be lifesaving in these patients.

Xander H. Wehrens, M.D., Ph.D.
Columbia University College of Physicians and Surgeons, New York, NY 10032
xw80@columbia.edu

Pieter A. Doevendans, M.D., Ph.D.
Utrecht University, 10032 Utrecht, the Netherlands

2 References

1. 1

   Redfern A, Smart J. Cardiac rupture. N Engl J Med 2003;348:609-609
   Full Text | Web of Science | Medline

2. 2

   Wehrens XH, Doevendans PA, Widdershoven JW, et al. Usefulness of sinus tachycardia and ST-segment elevation in V(5) to identify impending left ventricular free wall rupture in inferior wall myocardial infarction. Am J Cardiol 2001;88:414-417
   CrossRef | Web of Science | Medline