Determining the Cause of Death in a 72-Year-Old Woman: Osmosis USMLE Study Question

May 26, 2017

Answer: B. Myocardial rupture

Myocardial rupture is characterized by a laceration or tearing of the wall of the ventricles or atria of the heart. The most common cause of myocardial rupture is a recent myocardial infarction, with the rupture typically occurring 3 to 5 days after infarction. Other causes, may include cardiac trauma, endocarditis, cardiac tumors, and aortic dissection.

Myocardial rupture occurs in 2-3% of patients with transmural myocardial infarctions. This condition can be broadly divided into 2 categories: (1) acute or sudden and (2) subacute or progressive. Acute myocardial rupture is characterized by a severe cardiac tamponade and sudden death. Subacute myocardial rupture is characterized by the progressive formation of a wall hematoma, leading to pericardial effusion. Risk factors involved in myocardial rupture, include female sex, advanced age, first myocardial infarction, and hypertension.

Patients present with acute hemodynamic deterioration (ie, hypotension, abnormal heart rate, cold extremities, peripheral cyanosis). Upon gross pathology, a myocardial infarction (3-7 d after) presents with a yellowish lesion with hyperemic borders. Hemopericardium is a common finding in patients who suffered from a left ventricular free wall rupture. Most patients with a myocardial rupture involving the left ventricle free wall die immediately. Mainstay therapy is urgent surgical correction.

Major Takeaway: The most common cause of myocardial rupture is a myocardial infarction. Myocardial rupture is characterized by a laceration or tearing of the wall of the ventricles or atria of the heart. Patients classically present with acute hemodynamic deterioration and sudden death.

For more on myocardial rupture, read here.

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