Hypertension and cardiac rupture. A clinical and pathologic study of seventy-two cases, in thirteen of which rupture of the interventricular septum occurred

Document Type

Article

Publication Date

1-1-1942

Publication Title

American Heart Journal

ISSN

00028703

E-ISSN

10976744

Abstract

1. 1. In a series of 25,000 autopsies at the Los Angeles County Hospital between July 1924, and August 1941, there were 865 hearts which contained unhealed infarcts caused by coronary disease. 2. 2. Among these were 72 instances of spontaneous rupture through an area of ventricular infarction; 50 (70 per cent) were on the anterior surface of the heart. In 13 instances the rupture was through the interventricular septum. 3. 3. Scarring was present in 58.4 per cent of the unruptured hearts and in only 26.3 per cent of the ruptured hearts. 4. 4. In the ruptured hearts the infarcts tended to be smaller, more completely necrotic, and more heavily infiltrated with polymorphonuclear leucocytes. 5. 5. Of 100 patients who had nonfatal myocardial infarction, 23 (23 per cent) had a blood pressure of 140 90 or above. The average blood pressure was 125 78. 6. 6. Of 657 patients who had myocardial infarction that terminated fatally without rupture, 210 (32 per cent) had a blood pressure of 140 90 or above. The average was 128 81. 7. 7. In 62 patients who died as a result of cardiac rupture, the blood pressure was 140 90 or above in 39 (63 per cent). The average was 148 93. 8. 8. The average calculated time between infarction and rupture was 7.4 days. Ninety-eight per cent occurred on or before the sixteenth day after infarction. Seventy-eight per cent occurred between the third and twelfth days. 9. 9. Among 368 patients with heart weights of 400 grams or more and a blood pressure of less than 140 90 after infarction, only 4 per cent had cardiac rupture. 10. 10. Rupture of the heart occurred in 25 per cent of the 28 patients whose hearts weighed less than 400 grams and whose blood pressures were 140 90 or above after myocardial infarction. 11. 11. In the first 12,500 autopsies in this series, done between 1924 and 1935, 266 instances of myocardial infarction and 23 (8.6 per cent) ruptures were observed. In the second half, done between 1935 and 1941, myocardial infarcts were present in 599 cases and ruptures in 49 (8.2 per cent). © 1942.

Volume

24

Issue

6

First Page

719

Last Page

733

DOI

10.1016/S0002-8703(42)90902-5

Link to Full Text

Share

COinS