ABSTRACT
Resumen: La rotura del septum interventricular es una complicación grave del infarto agudo de miocardio (IAM), aunque poco frecuente. Se evidencia clínicamente como un deterioro hemodinámico progresivo, posterior al infarto. El ecocardiograma transtorácico es el principal estudio de imagen para el diagnóstico y la corrección quirúrgica constituye el pilar del tratamiento, ya que conlleva menor mortalidad que el tratamiento médico. Presentamos el caso de un paciente joven con IAM inferior que en la evolución presenta esta complicación, siendo intervenido de urgencia, con recuperación posterior.
Summary: The interventricular septum rupture is a serious, although infrequent complication of acute myocardial infarction. It is clinically evident as a progressive hemodynamic deterioration, after the infarction. Transthoracic echocardiography is the main imaging study for diagnosis, and surgical correction is the mainstay of treatment, since it has lower mortality than medical therapy. We present the case of a young patient with an inferior acute myocardial infarction, who presents this complication in the evolution, and was urgently operated, with subsequent recovery.
ABSTRACT
Los aneurismas ventriculares y la ruptura del septum interventricular son complicaciones del infarto agudo del miocardio que pueden acompañarse de alta morbimortalidad. Se reporta el caso de un paciente con formación y ruptura de un aneurisma verdadero de la pared inferior y del septum interventricular inferior después de un infarto agudo de miocardio silente. Se discuten las características clínicas, diagnóstico y manejo de estas complicaciones potencialmente letales.
Ventricular aneurysms and interventricular septal rupture are complications of acute myocardial infarction and thesecomplications may have a high morbidity and mortality. We report the case of a patient with an aneurysm involving theinferior myocardium and the inferior interventricular septum following an acute silent myocardial infarction. The clinicalcharacteristics, diagnosis and management of these potentially lethal complications are discussed.
Subject(s)
Humans , Male , Aged , Heart Aneurysm/diagnosis , Heart Aneurysm/etiology , Costa Rica , Cardiomyopathies/surgery , Cardiomyopathies/complications , Cardiomyopathies/diagnosis , Cardiomyopathies/etiology , Myocardial InfarctionABSTRACT
Blunt chest trauma may cause a variety of cardiac injuries, such as cardiac contusion, congestive heart failure due to myocardial injury or disruption of intracardiac structures, and more severely, instantaneous death. Traumatic rupture of the interventricular septum secondary to blunt chest trauma is extremely rare. Rupture of the interventricular septum may occur almost immediately after injury or many days later. The most common site of rupture is in the muscular portion of the septum near the apex. The exact mechanism of ventricular septal rupture in blunt trauma is unknown but it is thought to occur by external compression of the heart between the sternum and the vertebrae or as a result of extreme changes in intrathoracic pressure during sudden deceleration. We report an autopsy case of intraventricular septum rupture due to blunt chest trauma. A comatous 28-year-old male was admitted to emergency room after blunt chest trauma by unidentified object. He was treated with supportive care but expired two days later. The autopsy findings were as follows. The dead boy was slightly slender. External wound and patterned bruise were not present. In submentopubic incision, both pleural fluid (right 700ml, left 450ml) and ascites (400ml) were noted. The posterior wall of left ventricle showed hemorrhage measuring 1cm in diameter. On opening the heart, there was interventricular septum rupture measuring 3.5cm in length. Other cardiac structures were unremarkable. On light microscopic examination, endothelial cell was not seen in ruptured portion and both lung showed severe congestion and edema.
Subject(s)
Adult , Humans , Male , Ascites , Autopsy , Contusions , Deceleration , Edema , Emergency Service, Hospital , Endothelial Cells , Estrogens, Conjugated (USP) , Heart , Heart Failure , Heart Ventricles , Hemorrhage , Lung , Rupture , Spine , Sternum , Thorax , Ventricular Septal Rupture , Wounds and InjuriesABSTRACT
Blunt chest trauma may cause a variety of cardiac injuries, such as cardiac contusion, congestive heart failure due to myocardial injury or disruption of intracardiac structures, and more severely, instantaneous death. Traumatic rupture of the interventricular septum secondary to blunt chest trauma is extremely rare. Rupture of the interventricular septum may occur almost immediately after injury or many days later. The most common site of rupture is in the muscular portion of the septum near the apex. The exact mechanism of ventricular septal rupture in blunt trauma is unknown but it is thought to occur by external compression of the heart between the sternum and the vertebrae or as a result of extreme changes in intrathoracic pressure during sudden deceleration. We report an autopsy case of intraventricular septum rupture due to blunt chest trauma. A comatous 28-year-old male was admitted to emergency room after blunt chest trauma by unidentified object. He was treated with supportive care but expired two days later. The autopsy findings were as follows. The dead boy was slightly slender. External wound and patterned bruise were not present. In submentopubic incision, both pleural fluid (right 700ml, left 450ml) and ascites (400ml) were noted. The posterior wall of left ventricle showed hemorrhage measuring 1cm in diameter. On opening the heart, there was interventricular septum rupture measuring 3.5cm in length. Other cardiac structures were unremarkable. On light microscopic examination, endothelial cell was not seen in ruptured portion and both lung showed severe congestion and edema.
