RAMB - Setembro 2017

13 / 105

Rupture of the myocardium in autopsied MI hearts
Rev Assoc Med B ras 2017; 63(9):733-735 733
IMAGE IN MEDICINE
Rupture of the myocardium in autopsied MI hearts
Valesca Bizinoto Monteiro1, Bianca Gonçalves Silva Torquato1, Guilherme Ribeiro Juliano1, Bárbara Cecílio da Fonseca1,
Flávia Aparecida de Oliveira2, Daniel Ferreira da Cunha3, Camila Lourencini Cavellani1, Luciano Alves M atias da Silveira1*,
Mara Lúcia da Fonseca Ferraz1, Vicente de Paula A ntunes Teixeira 1, Edson Luiz Fernandes4
1Sector of General Pathology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
2Sector of General Pathology, Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil
3Department of Internal Medicine, UFTM, Uberaba, MG, Brazil
4In memoriam
Summary
Study conducted at Universidade
Federal do Triângulo Mineiro (UFTM),
Uberaba, MG, Brazil
Article received: 11/16/2016
Accepted for publication: 2/5/2017
*Correspondence:
Address: Av. Frei Paulino, 30
Uberaba, MG – Brazil
Postal code: 38025-180
Although myocardial rupture occurs in only 2% to 4% of cases of acute myo-
cardial infarction (AMI), there is a high mortality rate due to acute cardio-
genic shock. We present the anatomopathological findings of three cases of
myocardial rupture in autopsied hearts in the last 30 years, with a diagnosis of
cardiac rupture in acute myocardial infarction. In these 30 years the percentage
of AMI with myocardial rupture was 0.2%. Risk factors for post-AMI myocar-
dial rupture include older age, atherosclerosis, diabetes mellitus and systemic
arterial hypertension.
Keywords: autopsy, cardiac rupture, cardiogenic shock, myocardial infarction.
Introduction
Although the rupture of the myocardium occurs in only
2 to 4% of the cases of acute myocardial infarction (AMI),
it is associated with high mortality mainly due to the
state of acute cardiogenic shock. This occurs in about
90% of the ruptures of the left ventricular free wall and
in 50% of the cases with rupture of the septum, with 5 to
24% of deaths being caused by AMI.1 The clinical/physi-
cal signs and symptoms include chest pain, dyspnea, bra-
dycardia and shock.2 The main risk factors for cardiac
rupture in patients not treated with thrombotic medica-
tion include older age, female gender, and the concurrence
of systemic arterial hypertension, smoking habit, seden-
tary life style and diabetes mellitus.2
Myocardial rupture post-AMI occurs in total arterial
occlusion as often as in cases with low collateral flow to
the infarcted area.3 The most affected coronary arteries
are the right (46%), the left anterior descending (42%),
and the left circumflex (11.53%).4 Although rupture may
involve the intraventricular septum and the papillary
muscle, the free wall of the left ventricle is by far the most
common. 5 About 95% of cardiac ruptures occur in the
first week, with 40% of the cases within the first 24 hours
post-AMI. Rupture rarely occurs after the 10th day, when
scarring has already taken place.5,6 The anatomopatho-
logical findings of three cases of rupture of the myocar-
dium, as a complication of a recent AMI, are presented.
Method
In our study, three cases of myocardial rupture post-AMI
were studied in individuals autopsied at the Clinical Hos-
pital of the Triângulo Mineiro Federal University (Uberaba
– Minas Gerais – Brazil). Our investigation includes all the
cases of autopsied patients in the last 30 years, during the
period from 1979 to 2009, with a diagnosis of cardiac rup-
ture as a result of a recent acute myocardial infarction. The
anatomopathological findings are presented, as well as the
importance of carrying out the autopsies in order to con-
firm the diagnosis. Our study was approved by the Research
Ethics Committee of UFTM with protocol number
56433316.3.0000.5154.
Results
Autopsy findings
Case 1: Female patient, 52 years, non-white, married, house-
wife, born in Montes Claros (Minas Gerais), residing in Ca-
nal São Simão (Goiás). The patient was brought to the hos-
pital in a clinical state suggestive of AMI, progressing with
the appearance of a precordial systolic murmur, and died
before surgery on January 19, 1979. The cause of death was