From the Guidelines
Left ventricular (LV) rupture is a life-threatening condition that presents with sudden, severe chest pain, profound hypotension, and cardiogenic shock, requiring immediate medical attention and surgical intervention for survival. The symptoms of LV rupture can be catastrophic and include severe chest pain, similar to a heart attack but often more intense and tearing in quality, accompanied by signs of cardiogenic shock, such as cold, clammy skin, decreased consciousness, and weak or absent peripheral pulses [ 1 ]. Patients may also develop sudden cardiac tamponade with distended neck veins, muffled heart sounds, and pulsus paradoxus [ 1 ].
Clinical Presentation
The clinical presentation of LV rupture can vary, but common symptoms and signs include:
- Severe chest pain
- Profound hypotension
- Cardiogenic shock
- Cold, clammy skin
- Decreased consciousness
- Weak or absent peripheral pulses
- Sudden cardiac tamponade with distended neck veins, muffled heart sounds, and pulsus paradoxus
- Acute heart failure symptoms like severe shortness of breath, pulmonary edema with pink frothy sputum, and rapid, irregular heartbeats
Diagnosis and Treatment
Diagnosis of LV rupture is rarely established before the patient's death, but in some cases, the presentation can be sub-acute, giving an opportunity for intervention if the condition is recognized [ 1 ]. Immediate echocardiography is essential for diagnosis, and temporary hemodynamic stabilization can be obtained by pericardiocentesis, fluids, and positive inotropes. However, immediate surgical intervention is necessary for any chance of survival.
Risk Factors
Risk factors for LV rupture include first myocardial infarction, anterior infarction, elderly, and women, as well as hypertension during the acute phase of STEMI, lack of antecedent angina or prior MI, absence of collateral blood flow, Q waves on ECG, use of corticosteroids or nonsteroidal anti-inflammatory drugs, and administration of fibrinolytic therapy >14 hours after symptom onset [ 1 ].
From the Research
Symptoms of LV Rupture
The symptoms of left ventricular (LV) rupture can vary, but some common signs include:
- Hypotension 2, 3, 4, 5
- Recurrent chest pain 5
- Syncope 5
- Electromechanical dissociation 5
- Cardiac tamponade 3, 5
- Pericardial effusion 3, 5
- High acoustic intrapericardial echoes 5
- Right atrial and right ventricular wall compression 5
- Hemopericardium 4, 5
Diagnosis of LV Rupture
Diagnosis of LV rupture can be made using various methods, including:
- Echocardiography 2, 3, 6, 5
- Two-dimensional color Doppler echocardiography 6
- CT scan 6
- MRI 6
- Pericardiocentesis 5
- Autopsy 4
Clinical Presentation
The clinical presentation of LV rupture can be unpredictable, but it is often associated with: