Re: Treatment

Posted By CCF Cardio MD-SGM on April 18, 1998 at 19:49:21:

In Reply to: Treatment posted by Mark on April 07, 1998 at 23:51:32:






My brother (42yrs) suffered a rupture of acute myocardial infarct.
My question is: If a physician was able to diagnos this problem 3 days before
the rupture(extremely high CK levels), what(procedure), if anything,
could have been done.
Your help would be greatly appreciated!






Dear Mark,
I infer that your brother suffered a myocardial infarction(MI) which was followed by a
myocardial rupture. This is a exceptionally serious outcome, indeed, and carries a very
high mortality.  Rupture following MI is one of the most dreaded of complications that
can occur in the setting of heart attacks.    Due to weakening of the muscular wall of the
heart-- a result of the dead tissue that occurs due to the MI-- the heart is more prone to
rupture.  Such a complication
can either be contained by tissues around the heart, sometimes affording a time-window to
operate and correct the problem, or can cause immediate death.  Occasionally, the
myocardial tissue can rupture at the sight of the ventricular septum (which borders both
the right and the left ventricles).  A rupture of this type is termed a ventricular septal
defect (VSD) which is also very serious, but affords a better chance for survival than
the "free wall" rupture.
I understand your question to ask whether the rupture should or could have been anticipated prior
to the event.   I regret to say that we are unable to predict such a complication.  It is true
that higher CK levels as well as some infarct locations can signal a higher risk of rupture.  
However, the vast majority of patients who experience MI's with very high CK's don't go
on to rupture.  The small percentage that do rupture (significantly less than one percent),
are at highest risk during the three to four days after MI.  Still, there's no precaution that
would reduce this risk substantially once the MI has taken place.
I  hope this information has been helpful.  The heart forum is intended to provide information
of a general nature to medical questions.  Specific diagnoses and therapies can only be
obtained by your personal physician.