A complication of a myocardial infarction (also known as a heart attack) that occurs rarely and most of the time is fatal is called myocardial rupture. Sometimes, surgery can help an affected person survive and live many years. When surgery is not an option, doctors may perform minimally invasive surgery. Moreover, before surgery, doctors may recommend some medicines and medical devices to improve heart function.
In other words, myocardial rupture is a complication of myocardial infarction in which the heart walls, muscles, or valves come apart. While it may happen during a heart attack, some people experience it within 10 days after it.
According to some studies, approximately 30% of people who had a heart attack and sudden death also had a myocardial rupture. About 10% to 20% of people who have a myocardial infarction have a rupture in their left ventricular free wall (the outer wall of the heart). Typically, the ventricle is the lower heart chamber that pushes blood out to the aorta and then throughout the body. The percentage of people who have a heart attack and also a rupture in the wall between the ventricles or lower heart chambers is lower than 0.4%.
What Are The Symptoms of Myocardial Rupture?
Usually, people who experience myocardial rupture experience the following symptoms. Examples include:
- Cardiac tamponade
- Pulmonary edema
- Respiratory failure
- Heart failure
- Cardiac arrest
- Chest pain (angina)
- Cardiogenic shock
If you or a loved one experiences any of the previous symptoms, immediately contact your healthcare provider. Otherwise, it may lead to death.
Causes and Risk Factors
This condition often occurs when a myocardial infarction damages the heart muscle and weakens it. Rarely, a rupture or tear may occur in a weak area of the heart due to the force of the pumping heart muscle. While anyone can develop this condition, doctors have identified some factors that could elevate their risk of developing it. Examples include:
- Age – People over 60 are more prone to myocardial rupture compared to younger individuals.
- Sex – Usually, women have an increased risk of developing cardiac rupture compared to men.
- Hypertension (high blood pressure) – Those who experience high blood pressure for long periods are also at higher risk of a myocardial rupture.
- Heart failure and anemia
- Infarct location and size
- Thrombosis
- Prolonged use of certain medicines – Examples include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and others. Furthermore, ACE inhibitors and beta-blockers often protect the heart muscle.
- Atherosclerosis
- Chronic kidney disease
- Recurrent chest pain
Is There a Way to Prevent Myocardial Rupture?
Unfortunately, in most cases, it is not possible to prevent this condition. However, doctors may recommend some tips to reduce the risk of developing a heart attack (the primary cause of myocardial rupture). Check some examples below:
- Stop smoking – If you have problems with smoking cessation, discuss it with your physician.
- Dietary changes – You should eat a heart-healthy diet, which includes whole foods, fruits, vegetables, lean proteins (such as fish), and healthy fats. Furthermore, it is recommended to limit trans fats, saturated fats, sodium, and added sugars.
- Regularly exercise – In general, it is recommended to aim for at least 150 minutes of physical exercise per week. It also helps get or maintain a healthy weight.
Additionally, the only way to survive a cardiac rupture is immediate treatment. That’s why most people who experience a cardiac rupture die.
Diagnosis
Usually, physicians start the diagnosis of this condition with a physical examination, in which they will listen to your heart. Thereafter, they will perform the following tests to confirm or rule out this condition. Examples include:
- TEE (transesophageal echocardiogram)
- Cardiac catheterization
- CT (computed tomography) scans
- Heart MRI (magnetic resonance imaging)
Treatment
While medicines can temporarily help with a myocardial rupture, the best treatment is surgery. Physicians may need to do surgery immediately or help you with temporary mechanical devices until the surgery day. Check below some options often recommended by doctors for people with myocardial rupture:
- ECMO
- Vasodilators
- Inotropes
- Diuretics (also known as water pills)
- Intra-aortic balloon pump to help the heart pump blood
- Left ventricular assist device
- Minimally invasive closure of a rupture
- Open-heart surgery
While the best option to treat a myocardial rupture is risky, you can live many years after a successful surgery.
Frequently Asked Questions
Can you survive a ruptured heart?
People with this myocardial infarction complication can survive with quick diagnosis and treatment. The best treatment for people who experience a myocardial rupture is open-heart surgery.
What happens with a ruptured heart?
- A rupture in the wall between the ventricles (two lower heart chambers) – When it occurs, it allows excessive blood to go to the lungs. As a result, it leads to a fluid buildup in the lungs (edema), dyspnea (shortness of breath), or even respiratory failure. The rupture in the mitral valve may cause heart failure because the blood begins to leak backward.
- A rupture in the free heart wall – This is the most common type of rupture, and most of the time, it is fatal because the blood begins to leak outside the heart into the chest.
What is the survival rate for myocardial rupture?
Early diagnosis and proper treatment significantly increase the survival rate (about 75%). In general, the mortality (death) rate from a cardiac rupture after blunt trauma is about 75% to 93%.
Can myocardial rupture occur days after a heart attack?
Although myocardial rupture can occur during a heart attack, it most commonly develops within the first 3 to 10 days after a myocardial infarction. During this period, the damaged heart tissue becomes weaker and more vulnerable to tearing.
Is myocardial rupture considered a medical emergency?
Yes. Myocardial rupture is a life-threatening medical emergency that requires immediate medical attention. Without prompt diagnosis and treatment, severe complications such as cardiac tamponade, cardiogenic shock, and sudden death can occur.
What are the different types of myocardial rupture?
There are three main types of myocardial rupture. For example:
- Free wall rupture, which affects the outer wall of the heart
- Ventricular septal rupture, which affects the wall separating the lower heart chambers
- Papillary muscle rupture – This type negatively affects structures that help the mitral valve function properly
Each type can lead to serious complications and requires urgent treatment.
How do doctors suspect myocardial rupture after a heart attack?
Healthcare providers may suspect myocardial rupture when a person who recently had a heart attack suddenly develops symptoms such as severe chest pain, low blood pressure, shortness of breath, fainting, or signs of shock. Imaging tests are usually needed to confirm the diagnosis.
Can myocardial rupture happen in people without a heart attack?
While myocardial infarction is the most common cause, myocardial rupture can rarely occur due to severe chest trauma, infections, certain inflammatory heart conditions, or complications from medical procedures involving the heart.
How long is the recovery after surgery for myocardial rupture?
Recovery varies depending on the severity of the rupture, the patient’s overall health, and whether complications occur. Some people may spend several weeks in the hospital and require months of rehabilitation and follow-up care to regain strength and improve heart function.
What complications can occur after successful treatment?
Even after successful treatment, some people may experience complications such as heart failure, irregular heart rhythms (arrhythmias), reduced heart function, blood clots, or recurrent cardiovascular problems. Regular follow-up appointments are important to monitor recovery and manage any ongoing issues. Ask your healthcare provider if you have any other questions.
