Cardiac rupture associated with thrombolytic therapy: Impact of time to treatment in the late assessment of thrombolytic efficacy (LATE) study

Becker, Richard C.; Charlesworth, Andrew; Wilcox, Robert G.; Hampton, John R.; Skene, A. M.; Gore, Joel M.; Topol, Eric J.

doi:10.1016/0735-1097(94)00524-t

Cited by 110 publications

(63 citation statements)

References 24 publications

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“…79 In general, thrombolysis shifts the time course of rupture, with an increase in early and a decrease in later rupture such that the overall rate is reduced. 80 Rupture should be strongly suspected in patients with small infarct size and shock. Echocardiography is instrumental in the diagnosis.…”

Section: Treatment Of Cs Due To Mechanical Complicationsmentioning

confidence: 99%

Cardiogenic Shock

2008

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ardiogenic shock (CS) occurs in Ϸ5% to 8% of patients hospitalized with ST-elevation myocardial infarction (STEMI). Recent research has suggested that the peripheral vasculature and neurohormonal and cytokine systems play a role in the pathogenesis and persistence of CS. Early revascularization for CS improves survival substantially. New mechanical approaches to treatment are available, and clinical trials are feasible even in this high-risk population. Most importantly, hospital survivors have an excellent chance for long-term survival with good quality of life. This review will outline the causes, pathophysiology, and treatment of CS with a focus on CS complicating myocardial infarction (MI.) The case will be made for viewing CS as a serious disorder with a high early death rate, but one that is treatable and that, if approached aggressively, can result in full recovery. The diagnosis is usually made with the help of pulmonary artery (PA) catheterization; however, Doppler echocardiography may also be used to confirm elevation of LV filling pressures. 1 Hypoperfusion may be manifest clinically by cool extremities, decreased urine output, and/or alteration in mental status. Hemodynamic abnormalities form a spectrum that ranges from mild hypoperfusion to profound shock, and the short-term outcome is directly related to the severity of hemodynamic derangement. MI with LV failure remains the most common cause of CS. It is critical to exclude complicating factors that may cause shock in MI patients. Chief among these are the mechanical complications: ventricular septal rupture, contained free wall rupture, and papillary muscle rupture. Mechanical complications must be strongly suspected in patients with CS complicating nonanterior MI, particularly a first MI. Echocardiography is the technique of choice to rule out these entities and should be performed early unless the diagnosis is extensive anterior MI and the patient is undergoing prompt percutaneous coronary intervention (PCI). In addition, the detection of valvular disease before angiography may alter the revascularization approach. Diagnosis and CausesHemorrhage, infection, and/or bowel ischemia may contribute to shock in the setting of MI. As with mechanical complications, a high index of suspicion is required to make these diagnoses in MI patients, and survival may depend on timely recognition and treatment.Any cause of acute, severe LV or RV dysfunction may lead to CS. Acute myopericarditis, tako-tsubo cardiomyopathy, and hypertrophic cardiomyopathy may all present with ST elevation, release of cardiac markers, and shock in the absence of significant coronary artery disease. Stress-induced cardiomyopathy, also known as apical ballooning or takotsubo cardiomyopathy, is a syndrome of acute LV dysfunction after emotional or respiratory distress that leads to CS in 4.2% of cases. 2 Acute valvular regurgitation, typically caused by endocarditis or chordal rupture due to trauma or degenerative disease, may also cause CS. Aortic dissection may lead to CS via acute,...

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Section: Treatment Of Cs Due To Mechanical Complicationsmentioning

confidence: 99%

Cardiogenic Shock

2008

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“…The MI causing a free wall rupture is often relatively small. Steroid use and late thrombolysis do not appear to increase the risk of LVFWR (8,9).…”

Section: Discussionmentioning

confidence: 96%

Myocardial infarction and left ventricular free wall rupture in a patient with a prior pericardiectomy

Gosal

Phillipp

Morris

2008

Canadian Journal of Cardiology

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L eft ventricular free wall rupture (LVFWR) is a rare complication of acute myocardial infarction (AMI), occurring in approximately 2% of cases (1), and is often fatal because of the development of hemopericardium and tamponade. We describe a patient in whom free wall rupture occurred in the setting of previous pericardiectomy. Despite ongoing mediastinal hemorrhage, the diagnosis was established at cardiac catheterization and by computed tomographic scanning of the thorax, and surgical repair was performed. CASE PRESENTATIONA previously well 59-year-old man suddenly developed left shoulder pain, followed by intense central chest pain with bilateral arm radiation and diaphoresis while picking up garbage. When seen at a local nursing station, his heart rate was 140 beats/min and his blood pressure was 80/50 mmHg. An electrocardiogram showed sinus rhythm with complete right bundle branch block. There was ST segment elevation in the inferolateral leads and ST segment depression in leads V1 through V4.His cardiac risk factors included cigarette smoking, borderline hypertension and diet-controlled diabetes. He had undergone pericardiectomy for tuberculous pericarditis in 1970. He had been taking no medications.He was treated with acetylsalicylic acid. Thrombolytic therapy was not administered because of a concern about the possibility of aortic dissection. On arrival to the emergency department at the St Boniface General Hospital (Winnipeg, Manitoba), his chest discomfort persisted. His heart rate was 146 beats/min and his blood pressure was 86/54 mmHg. There were no signs of congestive heart failure and no heart murmurs. The arterial pulses were intact.The peak creatine phosphokinase and troponin T levels were 1202 U/L and 5.97 μg/L, respectively. A chest x-ray revealed right pleural effusion with an unusual dense area in the region of the right hilum.A contrast left ventriculogram revealed extravasation of contrast through the posterolateral wall of the left ventricle. Coronary angiography revealed 70% to 75% occlusion of the mid-distal circumflex artery. The mid-distal right coronary artery and the left anterior descending artery had insignificant stenosis of 40% to 50%.A transient episode of cardiac arrest with pulseless electrical activity required endotracheal intubation, inotropic support and insertion of an intra-aortic balloon pump. His hemoglobin level fell from 112 g/L to 67 g/L, and an urgent blood transfusion was initiated.Emergency transthoracic and transesophageal echocardiography were performed. The acoustic window was limited. An echo-free space with several immobile septi was identified anterior to the right ventricle. Cardiac rupture was suspected. A computed tomographic scan of the thorax confirmed extensive mediastinal hematoma in communication with the left ventricle.The cardiac surgery department was consulted and the patient was taken directly to the operating room. A defect of approximately 1 cm 2 in the posterobasal wall of the left ventricle was repaired. Coronary bypass grafting was not at...

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“…After this period, the impact of thrombolytic therapy remains uncertain. The LATE (Late Assessment of Thrombolytic Efficacy) Study was not able to conclusively demonstrate that late use of thrombolysis increases the rupture rate, despite the fact that rupture occurs earlier [2,4]. The reperfusion phenomenon seems to favor early heart rupture due to the transformation of the ischemic infarction into hemorrhagic infarction [4].…”

Section: Commentsmentioning

confidence: 99%

“…Precocious and effective thrombolysis decreases the risk of heart rupture, maybe by limiting the extent of myocardial necrosis, thereby avoiding transmural infarction. But, the impact of late thrombolytic therapy in heart rupture remains unknown [2,3].…”

Section: Introductionmentioning

confidence: 99%

“…The use of thrombolytic therapy in the treatment of AMI, in spite of reducing the overall mortality, seems to accelerate the evolution to heart rupture, without necessarily increasing the incidence of this complication. Reperfusion phenomena seem to favor early heart rupture due to the transformation of ischemic infarction to hemorrhagic infarction [2].…”

Section: Introductionmentioning

confidence: 99%

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Reparo de rotura de ventrículo esquerdo após uso de tenecteplase no tratamento do infarto agudo do miocárdio

Guedes¹,

Filho²,

Hueb³

et al. 2005

Rev Bras Cir Cardiovasc

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Reparo de rotura de ventrículo esquerdo após uso de tenecteplase no tratamento do infarto agudo do miocárdioSurgical repair of left ventricular rupture after the use of tenecteplase in the treatment of acute myocardium infarction AbstractThe use of thrombolytic agents in the treatment of acute myocardium infarction represented an important impact in the reduction of overall mortality. But this did not alter the cardiac rupture rate. This complication must be recognized and treated quickly. The authors report on a case of surgical repair of an early left ventricle rupture, after the use of tenecteplase in association with non-fractioned heparin for the treatment of acute myocardium infarction.Descriptors: Myocardial infarction. Thrombolytic therapy, adverse effects. Heart rupture, post infarction.Article received in February, 2005 Article accepted in April, 2005Resumo A utilização do trombolítico no tratamento do infarto agudo do miocárdio apresentou um impacto importante na diminuição da mortalidade geral, porém não alterou a incidência da rotura cardíaca. Esta complicação deve ser reconhecida e tratada rapidamente, necessitando um alto nível de suspeição clínica. Os autores relatam um caso de reparo cirúrgico de rotura precoce de ventrículo esquerdo, após utilização de tenecteplase associado à heparina não fracionada, no tratamento do infarto agudo do miocárdio.Descritores: Infarto do miocárdio. Terapia trombolítica, efeitos adversos. Ruptura cardíaca pós-infarto. 183GUEDES, MAV ET AL -Surgical repair of left ventricular rupture after the use of tenecteplase in the treatment of acute myocardium infarction Braz J Cardiovasc Surg 2005; 20(2): 182-185

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Cardiac rupture associated with thrombolytic therapy: Impact of time to treatment in the late assessment of thrombolytic efficacy (LATE) study

Cited by 110 publications

References 24 publications

Cardiogenic Shock

Cardiogenic Shock

Myocardial infarction and left ventricular free wall rupture in a patient with a prior pericardiectomy

Reparo de rotura de ventrículo esquerdo após uso de tenecteplase no tratamento do infarto agudo do miocárdio

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