Cardiovascular Collapse in a 72-Year-Old Woman: Osmosis USMLE Study Question of the Week

September 28, 2018

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 3-5 days after infarction. Other causes include cardiac trauma, endocarditis, cardiac tumors, and aortic dissection.

Myocardial rupture 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, which can cause cardiac tamponade. 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). On gross pathology, the necrotic tissue within a myocardial infarction (3-7 days after) is yellowish with hyperemic borders. Hemopericardium is a common finding in patients who suffered from a left ventricular free wall rupture. The condition requires urgent surgical correction, but most patients with a myocardial rupture involving the left ventricle free wall die immediately.

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

For more on myocardial rupture, read here.

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