Treatment and surgery. Causes of pathology. Diagnosis and treatment methods

Often, the townsfolk are convinced that the gap heart muscle may be associated exclusively with serious herbs chest or under extreme stress.

In people's conversations, you can often hear phrases: fright / stress / a blow to the chest brought it to the point that a heart rupture occurred.

In fact, the mechanisms of the process of rupture of the heart muscle may be somewhat different. The only thing that the townsfolk are right about is a heart break - this is really very dangerous pathology, blowing away great amount human lives.

• The main types of pathology
• Who is at risk for developing this pathology?
• Causes and symptoms of the problem, how is an emergency diagnosed?
• Treatment
• Complications and consequences

The main types of pathology

Rupture of the heart - this is how practitioners usually call violations of the integrity of the heart muscle, its walls, partitions, various membranes, valves or other structures. According to modern statistics, most often, heart rupture is the most dangerous complication of a condition such as myocardial infarction.

At the same time, violations of the integrity of the heart muscle, in most cases, are accompanied by high mortality of patients, since timely, adequate medical care for such people cannot always be provided, due to various reasons.

The most common damage to the muscular walls of the left ventricle, although there are situations when there is a rupture of the right ventricular structures, papillary muscle fibers or interventricular septa.

Doctors distinguish several forms of such a pathology as heart rupture - these can be:

• external damage to muscle structures, leading to the filling of the pericardium with blood;
• and internal injuries, these include ruptures of valve structures, septa, etc. Such conditions can lead to displacement of the arterial and venous blood to the development of pulmonary pathology.

Based on the localization of the rupture site, physicians can also distinguish:

• damage to the left or right ventricle;
• damage to the left / right atria;
• ruptures of vascular structures.

Given the depth of damage to the heart muscle, the conditions that fall under the diagnostic conclusion, heart rupture, are usually divided into:

In addition, damage to the muscle fibers of the heart can be:

• One-time. Arising suddenly, leading to rapid cardiac tamponade of the heart, often ending in death;
• Slowly progressing. When damage to the muscle structure does not lead to emergency conditions and sudden death of the patient, but is characterized only by a gradual deterioration general condition sick.

Who is at risk for developing this pathology?

We have already noticed that most often the pathology under consideration occurs against the background of primary myocardial infarction, which mostly affects males.

However, according to statistics, heart rupture after primary cardiac ischemia occurs more often in the fairer sex.

Medical science refers to the risk factors for ruptures of the heart muscle after suffering an acute myocardial infarction the following:

• belonging to the female sex;
• reaching old age (patients over fifty are more likely to encounter such a formidable complication of a heart attack);
• asthenic physique, when older woman too low body mass index;
• prolonged progression of hypertension;
• long-term use of hormonal drugs by patients.

At the same time, it is impossible not to notice that in medical practice there are cases when a rupture of the muscular structures of the heart occurred in patients who are not at risk of developing this pathology, against the background of relative health!

Causes and symptoms of the problem, how is an emergency diagnosed?

Most common cause the development of damage to the heart muscle is undoubtedly a state of acute myocardial infarction, especially if the pathology proceeds in a transmural form that is difficult for the patient. However, rupture of the cardiac muscle structure can also be provoked by other pathologies. So, among other causes of heart damage of this nature, doctors call:

The symptoms of such an emergency condition as heart rupture cannot be considered specific, they are very similar to other emergency conditions in which ischemia, heart failure, and cardiac arrest occur. Symptoms of a ruptured heart muscle include:

Unfortunately, it is not possible to independently recognize the pathology and, most importantly, to distinguish it from other cardiac disorders.

When making a correct diagnosis, physicians must take into account the data: anamnesis of the disease and the patient's life, physical examination data, laboratory test results, electrocardiography or echocardiography data.

Among additional research, allowing to determine the development of the considered pathology, it is customary to call:

Treatment

It should immediately be noted that the treatment of ruptures of the heart muscle can only be emergency and only operational. Unfortunately, any drug therapy, in this case, acts solely as an addition to the main surgical treatment.

Preparation for such surgical treatment takes minimal amount time. At the same time, doctors try to stabilize hemodynamics by means of intra-aortic balloon counterpulsation, intravenous drip of nitrate solutions, or elimination of fluid from the pericardial cavity.

The most commonly used methods of surgical treatment for ruptures of the heart muscle involve:

Complications and consequences

It should be understood that the state of heart rupture is an incredibly dangerous pathology, when in the absence or untimely adequate surgical treatment, patients can lose their lives. Even those patients who have a slight, self-healed, rupture of cardiac tissues are extremely rarely able to continue their life without surgical treatment.

But even timely surgical treatment of the pathology in question cannot be a guarantee of successful rehabilitation of such patients.

Unfortunately, the prognosis of survival for any rupture of the heart muscle is mostly unfavorable or very doubtful.

Summing up, it should be noted that the rupture of cardiac tissues is a pathology that it is more logical to try to prevent by referring to measures general prevention. After all, even successful treatment such a pathology cannot guarantee the patient a complete recovery!

• Do you often have discomfort in the region of the heart (pain, tingling, squeezing)?
• You may suddenly feel weak and tired...
• Feeling high pressure all the time...
• About shortness of breath after the slightest physical tension and nothing to say...
• And you have been taking a bunch of medications for a long time, dieting and watching your weight ...

Early and late complications after myocardial infarction

Each disease, even a banal ARVI, can have a detrimental effect on the body in the future, and what can we say about myocardial infarction, stroke and other serious diseases?

From a myocardial infarction without the provision of professional medical care, a fatal outcome can occur in a short period of time. But if medical assistance was provided and the patient began to recover, in this case he should be ready for possible complications and even death in the first year after the attack. It should be noted that complications of myocardial infarction can occur both in the early stages and months after the attack.

Complications are classified according to the time of their onset from the moment of the attack, and they are:

• early, formed in the acute period of the disease;
• late, which were formed in the cicatricial period.

Early Complications

Early complications are the consequences of a heart attack that appear after the first 28 days. This period is the most dangerous. So, early consequences myocardial infarction can be divided into the following groups:

• violation of the heart rhythm;
• acute heart failure;
• mechanical damage to the heart;
• thromboembolic complications.

The early consequences of myocardial infarction are the most dangerous, and for this reason, one of the main tasks facing doctors during this period is to prevent the development of complications.

Heart rhythm disorder

The group associated with cardiac arrhythmia includes the following complications:

1. Bradyarrhythmia.
2. Flickering and fluttering of the ventricles.
3. Supraventricular and ventricular arrhythmias.

Bradyarrhythmia - quite common consequence myocardial infarction, in which healthy rhythm hearts. The main symptom of this complication is a pulse rate of less than 60 beats per minute, less often there are dizziness or loss of consciousness.

Blinking and fluttering of the ventricles is a chaotic and frequent contraction. Symptoms of the development of ventricular fibrillation are:

• low blood pressure;
• pallor;
• loss of consciousness;
• convulsions;
• dilated pupils.

In case of diagnosis, it is urgent to carry out cardiopulmonary resuscitation and defibrillation.

The most common complication of the early period is arrhythmia. It affects almost 90 percent of people who survived myocardial infarction. The main signs of arrhythmia include:

• rapid pulse;
• shallow breathing;
• dizziness;
• fatigue;
• fainting state;
• chest pain.

In the event of an arrhythmia, the patient needs urgent medical attention, as it can provoke cardiac arrest.

Acute heart failure

Complications associated with acute heart failure include:

1. Cardiogenic shock.
2. Pulmonary edema.

State cardiogenic shock It has high rate mortality. Indeed, because of it, in the shortest period, the pumping function of the heart decreases, thereby lowering the level of blood pressure and internal organs suffer. It is worth noting that cardiogenic shock develops quickly and sometimes even outstrips pain.

Cardiogenic shock is of the following types:

• reflex;
• arrhythmic;
• true.

Reflex cardiogenic shock occurs against the background of pain irritation. Its signs are lethargy, lethargy, grayish skin tone, cold sweat and low pressure. Cardiogenic shock of an arrhythmic type occurs against the background of the fact that heartbeat goes astray. The most dangerous type is true shock, with a lethal outcome in 90 percent. It is based on a sudden disruption in the ability of the myocardium to contract due to large damage and leads to sharp decline cardiac output.

Pulmonary edema occurs within the first week after an attack of myocardial infarction. The main cause of its occurrence is acute heart failure. When making a conclusion about pulmonary edema, urgent medical care is needed.

Mechanical damage to the heart

The group associated with mechanical damage to the heart includes the following complications:

1. Rupture and dysfunction of the papillary muscle.
2. Rupture of the outer wall of the ventricle.
3. Rupture of the intergastric septum.
4. Pericarditis.
5. Acute aneurysm of the left ventricle.

Rupture and dysfunction of the papillary muscle is the most dangerous form of mitral insufficiency. The symptoms are unexplained blood stasis in the patient followed by a rapid exit. This complication occurs on the second to seventh day after the attack and requires immediate treatment.

The rupture of the outer wall of the ventricle occurs due to the fact that during an attack the strength of the affected area is lost, and this is with certain conditions may cause a break. This type of complication is very dangerous, as it is accompanied heavy bleeding and can also cause cardiogenic shock. Signs of a break:

• chest pain;
• pressure drop;
• semi-conscious state;
• dyspnea;
• bluish skin tone;
• wheezing;
• the pulse is faintly palpable.

Rupture of the interventricular septum occurs within the first five days after an attack, and mainly people of retirement age, women, and people with hypertension or anterior infarction suffer from this. Signs of a break:

• dyspnea;
• increase in heart volume;
• swelling of the veins in the neck;
• changes in the size of the liver;
• noise in chest area;
• cardiac arrhythmias.

Pericarditis is an inflammatory process, and it occurs in only 10 percent of patients who survive a myocardial infarction attack. It develops if all three layers of the heart were affected in the patient, and inflammation developed on the pericardium. Signs of this complication are constant throbbing pains in the chest region, which are aggravated by sighing and movement. This effect may occur in the first four days, and is treated with aspirin.

The occurrence of an acute aneurysm of the left ventricle is due to an extended and deep myocardial infarction, as well as a repeated attack of a heart attack, arterial hypertension and heart failure. It occurs with a transmural type infarction. Symptoms of an acute aneurysm are increasing left gastric failure, pulsation, and others. It should be noted that when a patient is diagnosed with an acute aneurysm, surgical treatment is necessary, since it leads to rupture and threatens with a fatal outcome.

Thromboembolic complications

The group of complications associated with thromboembolic complications include:

1. Thrombus formation in the left ventricle.
2. Arterial thromboembolism.

Thrombi may form in the heart cavity. If blood clots are located in the cavity, then they are not dangerous, but when they leave the heart, thrombosis of the artery of another organ is possible, and can also provoke a stroke attack. Symptoms of thrombus formation are the following factors:

• dyspnea;
• low blood pressure;
• dizziness;
• tachycardia;
• semi-conscious state;
• chest pain;
• suffocation;
• pallor.

Arterial thromboembolism is a complication caused by blockage of blood vessels by blood clots that were formed on their walls. After the cessation of blood flow, the patient begins to feel a strong sharp pain. Arterial thromboembolism is quite often the cause of gangrene.

Late Complications

Late complications are the consequences of a previous myocardial infarction, which occur a month after the experienced attack. At a later stage, the following diseases may occur:

1. postinfarction syndrome.
2. chronic aneurysm.
3. Re-infarction.

Postinfarction syndrome is an immunological reaction of the body, as a result of which inflammation of the pleura, lungs, and pericardium can develop. Signs of postinfarction syndrome are:

• high temperature, about 40 degrees;
• pain in the chest and side;
• swelling in the region of the sternoclavicular and sternocostal joints.

Postinfarction syndrome is also called Dessler's syndrome. This complication does not appear until two to six weeks after the experienced attack.

A chronic aneurysm can form after about one to two months due to stretching of the scar that formed after the heart attack. The main signs include changes in the larger side of the size of the heart, pulsation in the supraapical region. Chronic aneurysm prevents normal operation heart, and then goes into heart failure.

Complications of myocardial infarction may concern not only cardiac activity, but also genitourinary system, gastrointestinal tract and psyche.

Types, causes and treatment of aneurysm of the interatrial septum

Aneurysm interatrial septum(MPP) is a curvature of the wall between the left and right atrium and belongs to the group of small anomalies in the development of the heart.

• Reasons for the appearance
• Types and symptoms
• Diagnostics
• Is an aneurysm dangerous?
• Complication of MPP anomaly
• Treatment
• Preventive actions

The essence of this anomaly lies in the fact that the atrial wall is bent, protruding to the side. At the moment, doctors have identified three forms of MPP anomalies:

• curvature to the left;
• curvature to the right;
• curvature S-shaped.

Reasons for the appearance

Mankind has known about such a disease as an aneurysm of the interatrial septum for a very long time, but despite this, in the entire history of medicine, no serious studies of this disease have been conducted. Today, experts in the medical field have not found an exact explanation for the appearance of this curvature of the interatrial wall.

Some doctors believe that the cause of the development of this anomaly in a newborn child is heredity, and some say that the aneurysm of the MPP is associated with a violation in the formation of connective tissues inside the heart during the development of the fetus in the womb.

A cardiac anomaly at the time of embryonic development occurs against the background of various destabilizing causes, mainly due to the presence of any infectious diseases at mother.

In most cases in adults, aneurysm of the IAS is the result of a previous myocardial infarction. All theories are supported by proven arguments, which means that the appearance of an MPP anomaly can be triggered by one of the three listed factors.

Types and symptoms

The symptomatology of the curvature of the MPP can be very different. Often, the symptoms of such a disease are similar to those of a myocardial infarction or heart failure. According to the speed of the course of the disease after a heart attack, doctors divide the MPP aneurysm into three types.

1. Chronic aneurysm of the MPP. Appears at the sixth week after myocardial infarction and the symptoms of this type are similar to those of heart failure.
2. Sharp form. Appears within two weeks after a heart attack. Symptoms of the acute form include fever, heart rhythm failure, the appearance of heart failure and leukocytosis.
3. Subacute form. The period of appearance acute form- the third to sixth week after a heart attack. In this case, the curvature of the interventricular wall is formed due to a violation of the formation of scars at the site of the infarction. Symptoms of the subacute form are manifested by shortness of breath, strong heartbeat, heart failure and fatigue.

Diagnostics

Diagnosis of the disease consists of several stages. At the first stage, it is necessary to consult a doctor who will explain in detail to the patient all the primary signs of an interventricular anomaly. At the second stage, a visual examination is carried out, namely, the detection of pulsations in the chest and epigastric region.

After identifying primary symptoms curvature of the MPP, the patient is sent for a number of studies, namely:

• electrocardiography;
• CT scan.

In some cases, such a disease is diagnosed with an ultrasound of the heart immediately at birth. After the birth of a child with a curvature of the interatrial septum, this pathology is very clearly visible.

The final diagnosis is established only on the basis of a differential study using dopplerometry of the open oval window.

Is an aneurysm dangerous?

Most people who have an atrial septal aneurysm are afraid of its rupture, but in reality it does not threaten them.

The pressure in both atria does not great strength to break the wall, both in a child and in an adult. In the event that this does happen, there will be no fatal consequences.

According to medical statistics, it is clear that in people with this disease there is a risk of blood clots in the anomaly, which, having come off, can cause a stroke. These clots are called emboli.

Embolic stroke, as confirmed by many years of research, is very common in patients with anomalies of the interventricular wall. However, an embolic stroke can be caused by other factors, and the MPP aneurysm has nothing to do with it. Embolus detachment sometimes occurs in the presence of other defects that are quite similar to an aneurysm. In the case when the size of the curvature of the interatrial septum does not exceed 1 centimeter, the risk of embolic stroke is very small.

Complication of MPP anomaly

This interventricular pathology is recognized as very dangerous. First of all, the curvature of the MPP can lead to disruption of the heart. In addition, because of the aneurysm, some adults are diagnosed with chronic heart failure.

With a rupture of the septum (applies only to the acute form of the anomaly), a detached blood clot can migrate not only to the brain, but also to one of the vital organs. In view of this, the patient has a renal infarction and gangrene of the extremities.

Treatment

Only those who are diagnosed with chronic or slowly developing aneurysm of the urinary bladder are subjected to conservative treatment. In this case, patients are prescribed complex drugs that normalize the work of the heart, improve its rhythm, promote metabolic processes in the myocardium and significantly lower blood pressure.

Elimination of interventricular aneurysm in acute and subacute form requires promptness from medical specialist, since in this case there is a risk of rupture of the heart.

Such treatment for this stage disease is extremely necessary, and thanks to modern technologies, surgery on open heart passes safely and quickly.

During the operation of the curvature of the MPP, a heart-lung machine is used. The type of surgical intervention is selected depending on the size of the curvature of the septum, and during the operation, the enlarged area of ​​the MPP aneurysm is resected, it is strengthened using artificial materials, and corrugated sutures are applied.

Preventive actions

Prevention of aneurysm of the interatrial wall completely coincides with complex measures that are aimed at protecting against coronary disease heart, atherosclerosis and myocardial infarction.

For those who suffer from acute myocardial infarction, prevention of interventricular curvature consists of strict control and adherence to an increased motor regimen for two months.

Within 2 months, the patient develops a strong scar. Also to preventive measures refers to the earlier appointment of an angiotensin-converting enzyme inhibitor, namely enalapril or captopril.

January 23, 2019 No comments

Ventricular septal rupture (IVS) is a rare but fatal complication of myocardial infarction (MI). The event occurs 2-8 days after the infarction and often provokes cardiogenic shock. The differential diagnosis of postinfarction cardiogenic shock should exclude free rupture of the ventricular wall and rupture of the papillary muscles.

To avoid the high morbidity and mortality associated with this disorder, patients must undergo emergency surgical treatment. In modern medical practice, postinfarction rupture of the IVS is recognized as an emergency surgical care, and the presence of cardiogenic shock is an indication for intervention. Long-term survival can be achieved in patients who undergo operative surgery. Concomitant coronary artery bypass grafting (CABG) may be required. The use of additional CABG can improve long-term survival.

The operation is performed with a trans-infarction approach and the entire reconstruction is done using prostheses to avoid strain. Advances in myocardial protection and improved prosthetic materials have made a significant contribution to the successful treatment of IVS rupture. Improved surgical techniques (eg, infarctectomy) and better perioperative mechanical and pharmacological support have helped reduce mortality. In addition, the development surgical methods to repair perforations in various areas of the septum led to improved results.

AT contemporary practice patients undergoing shunt repair tend to be older and more likely to have received thrombolytic agents, which can complicate repair. After successful recovery, survival and quality of life are excellent, even in patients over 70 years of age.

Pathophysiology

The septal supply comes from branches of the left anterior descending coronary artery, the posterior descending branch of the right coronary artery, or the peripheral artery when it is dominant. The infarction associated with IVS rupture is usually transmural and extensive. About 60% of cases occur with anterior wall infarction, 40% with a posterior or bottom wall. Rear gap IVS may be accompanied by mitral valve insufficiency secondary to infarction or papillary muscle dysfunction.

At autopsy, patients with a ruptured IVS usually have complete occlusion of the coronary artery with little or no collateral flow. The absence of collateral blood flow may be secondary to comorbidities arteries, anatomical abnormalities, or myocardial edema. Sometimes there are multiple perforations of the septum. This can happen at the same time or within days of each other.

Ventricular aneurysms are commonly associated with ventricular septal rupture after infarction and contribute significantly to hemodynamic compromise in these patients. The reported incidence of ventricular aneurysms ranges from 35% to 68%, while the incidence of ventricular aneurysms alone after MI without IVS rupture is significantly lower (12.4%).

On a natural history of postinfarction rupture of the IVS big influence hypertension, anticoagulant therapy, elderly age and possibly thrombolytic therapy. The natural history of patients with ventricular septal rupture after infarction is well documented and concise. Most patients die within the first week, and nearly 90% die within the first year; Some reports indicate that less than 1% of patients are alive after 1 year.

This bleak prognosis is a consequence of acute volume overload caused by both ventricles of a heart already affected by major myocardial infarction and sometimes extensive coronary artery disease (CAD) in locations other than those already infarcted. In addition, superimposed ischemic mitral valve regurgitation, ventricular aneurysm, or a combination of these conditions may be present, further impairing heart function. Suppressed left ventricular function usually results in impaired perfusion of peripheral organs and death in most patients.

Several sporadic reports indicate that some individuals with postinfarction IVS rupture who received medical treatment live for several years. Despite the fact that in non-surgical treatment While many medical advances have been made in these patients, including intra-aortic balloon pumping, these techniques have not eliminated the need for surgery.

Rupture of the interventricular septum is a rare complication of myocardial infarction. Although autopsy studies show 11% of cases of myocardial wall rupture after myocardial infarction, perforation of the septal wall is much less common, occurring at an incidence of approximately 1-2%.

Diagnostics

Radiography

According to chest x-ray, 82% of patients with ventricular septal rupture after infarction have left ventricular enlargement, 78% have pulmonary edema, and 64% have pleural effusion. These findings are nonspecific and do not exclude other causes such as papillary muscle rupture.

M-mode transthoracic echocardiography and transesophageal echocardiography are also used to diagnose postinfarction IVS rupture. Echo-CG results have been improved using color Doppler imaging techniques. In addition, echocardiography allows you to study the presence of any pathology of the mitral valve.

Electrocardiography

No electrocardiographic (ECG) signs can serve as diagnostic criteria for postinfarction IVS rupture, although an ECG may indeed provide some useful information. Persistent ST segment elevation associated with a ventricular aneurysm is common. ECG can reveal atrioventricular block in one third of patients. An ECG can also be performed to predict the anatomical location of a septal tear.

Catheterization and pressure measurement

Left heart catheterization with coronary angiography is recommended for all stable patients. This procedure is time consuming and has some degree of complications; accordingly, common sense is required when prescribing this diagnostic method.

An important diagnostic test for differentiating IVS rupture from mitral valve insufficiency is catheterization of the right heart with a catheter. In the presence of a rupture of the interventricular septum, the oxygen concentration between the right atrium and the pulmonary artery increases. In addition, pulmonary capillary wedge pressure monitoring is useful for differentiating acute mitral regurgitation as a result of rupture of the IVS.

Left and right pressure measurements are helpful in assessing the degree of biventricular insufficiency and are useful in monitoring response to perioperative therapy. While right-sided insufficiency is more common in patients with IVS rupture after infarction, left-sided insufficiency and refractory pulmonary edema are more pronounced in patients with papillary muscle rupture. However, one third of patients with postinfarction IVS rupture also have some degree of MR secondary to left ventricular dysfunction. Only rarely is an IVS rupture also associated with papillary muscle rupture.

Treatment

Pharmacological therapy

To begin pharmacological therapy in an attempt to ensure the hemodynamic stability of the patient. The goal is to reduce afterload on the heart and increase cardiac output forward.

Vasodilators can be used to reduce left-to-right shunting associated with a mechanical defect and therefore increase cardiac output. Intravenous nitroglycerin may be used as a vasodilator and may improve myocardial blood flow in individuals with severe coronary artery disease.

At separate application, inotropic agents may increase cardiac output; however, without changes in the ratio of pulmonary to systemic blood flow (Qp-to-Qs ratio), they markedly increase left ventricular work and myocardial oxygen consumption. The profound level of cardiogenic shock in some patients precludes treatment with vasodilators, which often requires the support of vasopressors.

Vasopressors markedly increase left ventricular function and myocardial oxygen consumption. In addition, they increase systemic afterload and further increase the Qp to Qs ratio, thereby lowering cardiac output and significantly increasing myocardial oxygen consumption.

Intra-aortic balloon counterpulsation provides the most important means temporary hemodynamic support. Intra-aortic balloon pumping reduces left ventricular afterload, thus increasing systemic cardiac output and decreasing the ratio of pulmonary to systemic blood flow.

Surgical therapy

Indications and contraindications

In view of the poor prognosis for patients receiving medical treatment, the diagnosis of postinfarction rupture of the interventricular septum is in itself an indication for surgery. Currently, most surgeons agree that early operation effective in minimizing the risk of mortality and morbidity. The success of surgical treatment depends on the rapid medical stabilization of the patient and the prevention of cardiogenic shock.

Relative safety of repair was established after 2-3 weeks or more after perforation. Since the edges of the defect have become stronger and more fibrous, the repair becomes safer and easier to carry out. A successful clinical outcome is associated with adequate closure of the IVS; therefore, if possible, look for multiple defects both before and during surgery.

Initially, recovery should be delayed only when the patient is hemodynamically stable condition, but there must be a high degree of confidence that the patient is indeed stable. In such patients, the condition may suddenly worsen and death may occur. Criteria for delayed surgical treatment include the following:

Adequate cardiac output

No signs of cardiogenic shock

No signs and symptoms of congestive heart failure (CHF) or minimal use of pressor agents to control initial symptoms

No fluid retention

Good renal function

The natural history of the disease is such that few patients present with these signs and symptoms. In most patients, rupture of the interventricular septum after a heart attack quickly leads to a deterioration in the hemodynamic state, with cardiogenic shock, severe and intractable symptoms of CHF and fluid retention. emergency operation usually needed. High surgical risk early recovery accepted because of the even higher risk of death without surgery under such circumstances.

In some cases, there is a delay in the diagnosis and appointment of surgical intervention. Although most patients with postinfarction rupture of the IVS require emergency surgery, the occasional patient, due to a delay in diagnosis or referral, may be in a state of multiple organ failure and may not be a candidate for surgery. The chances of such a patient surviving the operation are minimal; in these circumstances supporting medical therapy may be adequate. Patients who are in a coma and have cardiogenic shock have a particularly poor prognosis after surgery, and surgery is best avoided in such circumstances.

Forecast

Operative mortality is directly related to the interval between MI and surgery. In retrospective clinical analysis 41 patients treated for postinfarction ventricular septal defect confirmed that while female gender, older age, hypertension, acute anterior wall myocardial infarction, no previous acute myocardial infarction, and late arrival at hospital were associated with a higher risk of mortality from acute rupture IVS, the time from the onset of acute myocardial infarction to surgery was the most an important factor determining operative mortality and in-hospital survival.

If repair of a ruptured interventricular septum after a heart attack is performed 3 weeks or more after a heart attack, the mortality rate is approximately 20%; if it is performed before this time, the mortality approaches 50%. Most obvious reason This is that the higher the degree of myocardial damage and hemodynamic disturbances, the more urgent the need for early surgical intervention.

When using the early operative approach, most studies show an overall mortality rate of less than 25%. Mortality is generally lower in patients with anterior IVS rupture and lowest in patients with apical IVS ruptures. For anterior defects, mortality ranges from 10% to 15%; for posterior defects, mortality ranges from 30% to 35%.

Heartbreak is a concept familiar to every person. Many people think that you can get such damage from a strong fright or experience, but this is not true. Anxiety and stress usually have nothing to do with it, a certain disease more often leads to this deadly condition. However, there is a risk of tearing the tissues of the main organ due to fear and other emotional stress, but this happens extremely rarely. To protect yourself from this pathology, you can, most importantly, understand what provokes its development and what drugs can stop this serious process.

What is a heart break? This condition is caused by a violation of the integrity of the tissues of the organ, its walls and other departments. main reason similar disease lies in myocardial infarction. It is as a result of this severe pathology, which arose for the first time, that the tissues of the organ are stretched and ruptured. When the disease is fixed again, it can no longer cause a rupture of the heart, since the scar formed after the first heart attack is quite strong and resistant to hypoxic lesions and ischemia.

People young age more often the elderly are prone to such disorders. Physicians classify such injuries as internal (they reveal a rupture of the fibers of the septum between the ventricles of the organ, as well as papillary muscle tissue), external and external. In addition, there is also a division into 3 types.

Characteristics of varieties:

Among other things, there are varieties of heart rupture that are associated with other causes and refer to one-time damage, as well as to slow-flowing and gradually progressive.

A complete rupture of the organ is recorded only in the case of deep violation tissues, distributed throughout the depth of tissues.

An incomplete type of microtrauma is observed with such a defect that affects the fibers of the heart muscle not to the full depth, after which an aneurysm develops.

Rupture of the aorta occurs due to dissection of all layers of this department of cardio-vascular system. This is due to the flow of blood between the walls. Among other things, damage to the valve of the main organ is often recorded, which appears under the influence of trauma or pathology of the heart.

Rupture of the left ventricle of the heart occurs most often, and its right calving or a similar atrial defect is diagnosed only in very rare cases.

The reasons

Each person is at risk of developing a gap, but the female sex suffers from this pathology more often than the male. Most often, such disorders occur due to a heart attack, but there are other predisposing factors. The rupture of the heart, formed from fear, is considered only a concept that speaks of the possibility of such a consequence of fear. Sudden death in people who have suffered an emotional shock is due not only to such damage. In fact, if a person has been subjected to such a psychological impact, myocardial infarction may first develop from stress, and as a result of it, an organ rupture already appears.

It is believed that such a destructive phenomenon may appear due to high blood pressure. However, this fact has not been confirmed and remains only a theory. Some doctors believe that high level diastolic index leads to such damage.

Statistical data show that in 59-100% of patients with this microtrauma of the organ, the lower arterial pressure was high.

For this reason, during a myocardial infarction, medications are needed that reduce the rate of blood pressure on the walls of blood vessels so that there is no rupture of the aorta of the heart or other parts of it. Medicines help reduce the load on the organ, so that the risk of integrity is minimized.

Provoking factors:

1. The age category of people who are already over 50-55 years old. The healing process of any damage takes much longer, which is why the scar after myocardial infarction is formed much more slowly.
2. Arterial hypertension.
3. Infarction therapy was started out of time, the drugs began to be used late, after 24 hours after the onset of the pathology.
4. Excessive exercise during the first 7-9 days after a heart attack.
5. Too low body weight. In patients with a weakened body, all processes slow down, including the formation of a scar on the heart after a heart attack.
6. The use of hormonal drugs, as well as non-steroidal anti-inflammatory drugs. These drugs slow down the formation of a scar on the organ after a heart attack.

There are certain pathological processes, which can provoke a rupture of the aorta of the heart or its other departments.

Main reasons:

• Endocarditis, which manifests itself inflammatory process on the inner lining of the organ.
• Myocardial infarction or death of a small area of ​​the heart muscle, resulting from blockage of the feeding artery. The most common reason for a break.
• Diseases characterized by infiltration of the organ tissue (hemochromatosis or the development of amyloidosis, and also sarcoidosis). Such pathologies contribute to the accumulation of certain elements in the fibers of internal organs. These substances are not normally present. For example, a compound of carbohydrate and protein called amyloid.
• Neoplasms in the organ and nearby areas.
• Damage to the heart of a congenital nature or anomalies of its development. In this case, there is a thin area in the tissue of this zone, which is easily destroyed even with a small load.

The aortic type of this damage is formed due to the thinning of the internal flexible membrane, after which a lumen appears, through the fault of which blood begins to leak. Usually, wall separation is considered a dangerous condition, resulting in death.

In a completely healthy person, an organ rupture can occur under the influence of strong fear. At the moment of an extreme situation, the heart rate increases many times, and the strength of the blood flow increases. This process leads to an accelerated synthesis of adrenaline, which affects the left and right ventricles, leading to their fibrillation. The pumping of blood stops, and this provokes a fatal outcome.

It is almost impossible to save a person who has a violation of the integrity of the main organ, therefore it is necessary to minimize the risk of such a defect.

Symptoms

How painful and pronounced the signs of heart rupture will be depends on how badly the myocardium is damaged, the degree of change in hemodynamic processes, and the presence of hemopericardium formation. If the defect is small, when blood does not enter the area of ​​​​the shirt of the organ or there is a small volume of it there, then the symptoms of the pathology will occur gradually, intensifying over time.

Signs:

1. Severe pain behind the sternum on the left, arising abruptly.
2. Fear of death, anxiety, restlessness, psychomotor agitation may appear.
3. Blueing of the skin.
4. Edema of the extremities.
5. Difficulty breathing, shortness of breath even at rest.
6. Increased heart rate.
7. Discharge of sticky sweat.
8. A strong decrease in blood pressure.
9. Cough with sputum that is frothy and pink in color.

If a heart rupture is of a slowly progressive type, then the person behaves restlessly, tries to neutralize the pain with the help of Nitroglycerin, but does not achieve the desired effect. Discomfort behind the sternum may weaken a little, but after a while it resumes with renewed vigor. The course of the pathology is further aggravated by the fact that the vessels of the heart do not receive blood in the required volume, as a result of which the myocardium experiences a strong oxygen starvation, which inevitably leads to its insufficiency.

The acute nature of the disease can rupture the tissues of the organ abruptly, which in any case leads to the flow of blood into the bag of the heart (hemopericardium), the systemic blood flow suddenly worsens. This can mean a quick onset of death, since the ambulance team usually does not have time to help the patient. In order to prevent such a difficult outcome, it is necessary to pay attention to the harbingers in time. similar pathology. People suffering from heart ailments need to know what symptoms can occur before a rupture of the main organ.

Danger signs:

• loss of consciousness;
• pronounced cyanosis (blue skin);
• veins in the neck swell strongly;
• tissue swelling is becoming more noticeable;
• measurement of the pulse becomes impossible, it is not palpable;
• pronounced shortness of breath stops abruptly, the patient's breathing stops.

Hemotamponade of the pericardial zone can occur not only due to myocardial infarction, but also with heart injuries, as well as rupture of the aorta in the region of its initial section. Sudden pain and the development of cardiogenic shock are the main symptoms of tamponade. Such signs have increasing manifestations, within a few minutes after their disappearance, the death of the patient is usually recorded.

Any disturbances in the myocardium cannot go unnoticed, and the risk of death increases significantly if a large-focal transmural type infarction is detected. It is especially dangerous when arterial hypertension is additionally diagnosed in a person and the patient's age is already advanced.

Diagnostics

Evaluation of a patient with a major organ rupture should begin as soon as possible, as delay can lead to death. Methods that allow you to accurately diagnose "heart rupture" are prescribed by the doctor individually for each patient, based on their manifestations of the disease.

Examination methods:

1. Physical examination. The doctor examines the patient's skin color, his pulse, the presence of tissue swelling, and measures blood pressure. Listening to the organ by auscultation is an important diagnostic measure, since when it is carried out, the doctor can identify characteristic noises that indicate a similar defect.
2. A BAC (biochemical blood test) is needed to identify additional pathological processes, to examine the level of cholesterol, urea, uric acid, sugar, creatinine and other substances.
3. An expanded type coagulogram is performed to determine the coagulation characteristics of the blood.
4. A general urine and blood test is necessary to detect concomitant diseases.
5. Determination of the level of troponin T and I in the blood. These elements are present in the cells of the muscle fibers of the heart and are released into the blood if such cells are destroyed.
6. ECG (electrocardiogram).
7. EchoCG (electrocardiography) allows you to detect the place of rupture of the organ, visible on the monitor. The doctor assesses the size of the damage, its exact localization, the presence of blood in the pericardium and its volume. Even with the help of such an ultrasound examination, you can see a change in blood flow, a violation of the contractile features of the heart.
8. The catheterization method involves the introduction of a catheter into the right parts of the organ to measure the level of oxygen in them. If there is a rupture of the septum between the ventricles of the heart, then the blood enriched with oxygen enters the right ventricle from the left. When such an examination reveals that the volume of oxygen in the right ventricle is significantly higher than in the right atrium, it means that damage to the heart tissue is possible.

Timely diagnosis helps to save the life of the patient, so it is important to deliver the patient to the hospital department as soon as possible.

Treatment

The only way to save a person from rupture of an organ is by applying surgical intervention. Drugs are powerless here, but in the period before the operation, doctors prescribe an intravenous infusion of certain medications to support the work of the heart. It is also sometimes advisable to install an intra-aortic balloon counterpulsation for a patient in order to partially restore the pumping activity of the organ. Means that reduce vascular resistance are also needed, for which solutions of a variety of nitrates are used. Elimination of fluid from the pericardial sac is also often necessary for the patient. For this purpose, a needle is inserted into the pericardial area, through which fluid is sucked off.

Surgical treatment includes several methods of performing operations, during which it is possible to eliminate a defect on the heart or inside it. As a last resort, when to restore damaged tissue impossible, doctors resort to organ transplantation.

If we talk about the prognosis of such a disease, then they are disappointing. Every patient with a ruptured heart needs urgent hospitalization. When help is late, the person dies. Even when the appearance little damage, which independently closed with a thrombus, such a patient does not have long to live in the absence of timely medical manipulations and surgical treatment. It is sad that with quick surgery and other actions of doctors, there is little chance of avoiding death, only half of these people survive. Sutures placed on myocardial tissue may erupt.

Preventive measures

To prevent serious diseases of the main organ, in particular, its rupture, it is necessary to follow some recommendations of doctors on this matter. If stick certain rules, then the risk of dangerous states will decrease significantly.

Prevention methods:

1. Settle level bad cholesterol in blood. To do this, it is necessary to establish a diet, to abandon the use of animal fats, which contribute to the synthesis of such harmful substance. Drugs can also help in this process, but only a doctor should prescribe them.
2. Rejection of all bad habits.
3. Contact a medical facility if you experience pain behind the sternum and do not disappear within 5 days.
4. Monitor the level of blood pressure, avoiding its sudden changes.
5. Timely therapy of any cardiac pathologies.
6. In case of myocardial infarction, it is necessary to carefully follow all the recommendations of the attending doctor regarding medication and other aspects.
7. Monitor your condition in case of the flu, as this viral disease increases the risk of damage to the integrity of the organ.

Each person is able to independently help himself if he is attentive to his health. Rupture of the heart is a serious disease that often leads to death.

Cardiological ailments require special attention, since they are all deadly. Violation of the integrity of the organ is a serious pathology that can be eliminated only with timely surgical intervention. At the first manifestations of this disease, you should immediately consult a doctor.

In the first week of infarction, the scar is not yet fully formed, and in the presence of risk factors (high blood pressure, extensive damage, physical activity), a wall rupture may occur. This complication is most often poor prognosis for the life of the patient. For treatment, only surgical intervention can be used - stitching the wall or septum between the ventricles.

Read in this article

Causes of a heart rupture

Myocardial infarction is the most probable cause heart rupture, but it can also occur with tumor destruction of myocardiocytes, endocrine diseases. The immediate cause of the rupture of the muscle layer during necrosis of the heart muscle is the weakness and softening of the wall to the formation of a dense connective tissue. Therefore, the most likely time of development is the first week from the onset of a heart attack.

Factors that increase the risk of this complication:

• age of patients - in older people, the duration of damage recovery is longer;
• female;
• extensive, penetrating through the entire thickness of the myocardium () necrosis;
• high degree of arterial hypertension;
• severe coughing or vomiting;
• motor excitation;
• primary heart attack (there were no previous angina attacks);
• bouts of chest pain in early period infarction as evidence of the spread of the lesion;
• untimely diagnosis and treatment (more than a day from the beginning);
• early physical activity (violation of bed rest);
• taking corticosteroids and nonsteroidal drugs to relieve inflammation, they prevent the formation of a scar in the area of ​​necrosis;
• the beginning of thrombolytic therapy later than 12 hours from the onset of a heart attack.

Types of rupture of the myocardial wall

Depending on the place of violation of the integrity of the muscular layer of the heart, the following types of pathology are distinguished:

• external - blood flows from the chambers of the heart to the pericardium with the development of tamponade,
• internal - a partition between the ventricles or internal (papillary) muscles.

Left ventricular ruptures are the most common; the atria and right ventricle are rarely injured.

By development time:

• early - up to 72 hours from the onset (more often with extensive and deep infarction),
• late - after 3 days, provoke their hypertension, stress on the heart.

Depending on the breaking speed:

• simultaneous - a sharp gap with pericardial tamponade,
• long - slow flowing with a gradual increase in symptoms.

When examining the structure of the myocardium, damage can affect the entire thickness ( complete break) or be incomplete. In the latter case, an aneurysmal protrusion of the muscle layer is formed.

Signs of complications of myocardial infarction

The harbingers of the emerging gap are:

• increasing, not decreasing from the use of analgesics and nitrates;
• sticky and cold sweat;
• weak pulse.

With a sudden rupture of the wall, blood from the chambers of the heart enters the pericardial sac, which leads to tamponade, compression of the myocardium from the outside and cardiac arrest.

Patients are in an unconscious state, there is intense cyanosis of the skin of the face, hands, chest, the neck veins overflow with blood, it is difficult to determine the pulse and pressure. The cessation of breathing and heart work occurs in a matter of minutes. Therefore, most often it is impossible to save the sick.

The slow development of the gap can be for several hours and even up to 2 - 3 days. Clinical manifestations in such cases are as follows:

• intermittent severe heart pain - undulating and increasing, not amenable to treatment;
• progressive hypotension;
• difficulty breathing;
• increase in cyanosis of the skin.

Prognosis for myocardial rupture

This complication of a heart attack is an extremely unfavorable consequence, since when it occurs, an operation is required within a few minutes, which is usually difficult to perform even in a hospital. Therefore, most often myocardial rupture is considered fatal, but if the area of ​​damage is insignificant, then a tear forms at the site of the tear. blood clot, there are isolated cases of survival of patients, even without surgery.

With timely treatment, the chances of recovery increase, but such patients should observe a sparing regimen for a long time and be under the supervision of doctors, since the sutures on the myocardium must heal under conditions of complete unloading of the heart.

Prevention of heart attack and its complications

In order to reduce the risk of coronary heart disease and all its consequences, it is necessary:

• control blood cholesterol levels, avoid animal fats, take lipid-lowering drugs;
• maintain blood pressure in the range of 120 - 140/80 - 90 mm Hg. Art.;
• completely give up smoking, alcohol and self-medication;
• in case of pain in the heart, undergo a complete cardiological examination;
• if an angina attack lasts more than 15 minutes, you need to call an ambulance.

Rupture of the heart muscle is an extremely severe complication of myocardial infarction, its development is usually sudden. Pathology can be provoked by early physical activity, extensive and penetrating into all layers, the affected area. A chance to save a life can only be a timely operation.

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Depending on the time of onset, as well as the complexity, such complications of myocardial infarction are distinguished: early, late, acute period, frequent. Their treatment is not easy. To avoid them, prevention of complications will help.

Rupture of the heart, myocardium: background, forms, signs, help, prognosis

Without exaggeration, the heart is considered the main organ in the circulatory system, without which blood delivery to the internal organs is impossible. If it is damaged, hemodynamics is disturbed, and heart rupture (PC) makes the movement of blood impossible, and the patient dies from shock.

Rupture of the heart muscle - myocardium is a violation of its integrity, which most often occurs due to a heart attack. Contrary to popular belief, a rupture cannot occur on its own from fear or intense fear, because the heart is a powerful muscular organ, and prerequisites in the form of changes in the myocardium are necessary for its damage.

Elderly people, especially women, as well as patients suffering from diabetes, hypertension, are more susceptible to heart rupture. Taking certain medications, late initiation of treatment for a heart attack may be accompanied by a slowdown in scar formation, which creates the preconditions for a rupture. The rupture of the heart vessels, the initial section of the aorta is provoked by a deep atherosclerotic process, vasculitis.

Causes and types of heart failure

Causes of heart failure include:

• Injuries of the chest organs;
• congenital;
• exchange violations.

The causes of heart wall rupture lie in structural changes, because A healthy myocardium is quite strong and, at the same time, elastic, so it cannot burst.

Infarction (necrosis) of the heart muscle is considered the most common cause of heart rupture.. With this disease, a rupture occurs in about 3% of cases, and in about half of patients it occurs on the first day from the onset of necrosis. Over the next two weeks, the likelihood of a rupture increases significantly.

rupture of the heart as a result of a heart attack (arrows indicate areas of necrosis)

With myocardial infarction, a rupture of the left ventricle of the heart usually occurs, since it is this department that experiences the greatest load during the work of the organ, and it is in it that necrosis usually appears. Up to 3% of cases may be accompanied by a violation of the integrity of the septum between the ventricles. The precursor to the rupture is a massive infarction that affects a significant amount of the heart muscle, and the risk of damage is maximum in the first two weeks. The right departments and auricles are broken exceptionally seldom.

Endocarditis (inflammation of the inner layer of the heart), tumors, metabolic disorders(amyloidosis) lead to a change in the state of the heart muscle, which becomes very susceptible to stress and may break. With endocarditis involving the valvular apparatus, rupture of the heart valve is likely, which is fraught with acute heart failure.

Among other causes of rupture of the wall of the heart indicate trauma. For example, in an accident knife wound, strong blow in certain sports or a fight.

Many people think that there is a rupture of the heart from fear, and this is evidenced by cases of sudden death with a strong emotional shock. Indeed, with a post-mortem examination of the heart, it is possible to diagnose it from a rupture, but the cause of a defect in the myocardium is more often a heart attack, which, among other things, can be triggered by stress, fear, and strong excitement.

on the left - postinfarction rupture of the myocardium (heart muscle), on the right - outer gap hearts with hemotamponade

In addition to the immediate causes, there are also predisposing factors:

1. Old age - after 50 years, regeneration processes slow down, and most people of this age already have certain signs or wear of the heart muscle;
2. , creating additional load on the myocardium;
3. Delayed treatment of acute myocardial infarction;
4. Early activation of the patient with extensive heart attacks - even walking on the street or walking around the ward requires an increase in myocardial work, so the motor regime is usually limited;
5. Exhaustion, low body weight of the patient contribute to the slower formation of a scar in the area of ​​necrosis, which is fraught with a rupture in acute period heart attack;
6. Taking drugs containing hormones, as well as non-steroidal anti-inflammatory drugs, slows down the formation of connective tissue in the heart attack.

Depending on the site that has undergone a rupture, the time of manifestation of the pathology, various options for rupture of the heart are distinguished. According to the localization of the damage zone, the following are possible:

different types of heart failure

• External breaks when formed through defect in the wall of the heart through which blood enters the heart sac.
• Internal ruptures, when the structures of the organ located inside it are damaged: rupture of the papillary muscles, the formation of a defect in the septum.

The blood inside the heart moves under great pressure, and when defects appear in the myocardium, it instantly rushes into the cavity of the heart shirt, limited by the pericardium. The rapid filling of the pericardial cavity with fluid disrupts the contraction of the heart, its tamponade occurs and stops. There is a shortage of blood flow in the organs, and the patient dies from shock.

Internal ruptures can flow more easily than external ones. So, with a partial rupture of the papillary muscle, the patient can live up to two weeks, but this condition somehow requires urgent surgical treatment. Incorrect movement of the valve leaflets when papillary muscles or chords are damaged causes acute heart failure and is deadly. Septal ruptures are accompanied by the movement of blood through the defect from the left half of the heart to the right and can also lead to the death of the patient.

If the rupture occurred within up to three days from the moment of necrosis or injury, then it will be called early. After 72 hours, when the recovery processes have already begun, but the scar is very tender, the rupture is provoked by excessive physical activity and is called late.

With extensive infarcts, it is possible simultaneous gap, and then death comes suddenly. If the defect does not extend to the entire depth of the myocardium or is relatively small, then instantaneous death does not occur, blood circulation progressively worsens, and the damage is called slowly flowing.

How does MS manifest itself?

Symptoms of heart rupture depend on the area of ​​the lesion in the myocardium, the presence of hemopericardium, and the degree of hemodynamic disturbance. With a relatively small defect, when blood does not enter the cavity of the heart shirt or its amount is insignificant there, the signs of the disease increase over several hours, ten minutes, while the patient is concerned about:

1. Sharp, very intense pain behind the sternum, in the heart;
2. Severe anxiety, possibly psychomotor agitation;
3. Dyspnea;
4. Blueness of the skin;
5. Puffiness.

With the progression of the symptoms of acute heart failure, the pulse becomes thready, blood pressure drops, a change in consciousness or even loss of consciousness is possible. There is pain in the right hypochondrium, associated with an increase in the liver with stagnation of venous blood, swelling increases.

A patient with slowly progressive MS is restless, tries to relieve pain with the usual nitroglycerin, but does not get any effect, the pain may decrease somewhat, but then reappears. Characterized by cold clammy sweat, palpitations and hypotension. The condition is aggravated by the fact that the arteries of the organ do not receive the blood they need, the myocardium experiences severe hypoxia, and its failure is inevitable.

An acute rupture of a large heart inevitably leads to an outflow of blood into the heart sac (hemopericardium), the systemic blood flow is sharply disturbed, and the patient dies. In more than 90% of cases, doctors are faced with just such sudden and large myocardial ruptures. Often, the called ambulance simply does not have time to provide first aid and is only forced to state the sudden death of the patient.

Harbingers of a broken heart can become intense pain that is not relieved by nitroglycerin and even narcotic analgesics, blood pressure drops sharply, the pulse becomes thready, palpable with great difficulty, the patient turns pale, cyanosis of the skin increases, consciousness becomes confused.

Symptoms of external rupture are reduced to signs of pericardial hemotamponade and acute heart failure:

• The patient loses consciousness;
• The cervical veins swell, swelling increases;
• Severe cyanosis appears;
• Severe shortness of breath is replaced by respiratory arrest;
• It is impossible to feel the pulse, hypotension is replaced by shock with no pressure.

Hemotamponade of the pericardium is possible not only with ruptures against the background of a heart attack, but also with traumatic injuries heart, rupture of the aorta in its initial section. sudden pain and signs of cardiogenic shock are the main manifestations of hemotamponade. Both aortic rupture and myocardial infarction can have general arrangements development, therefore all patients are at risk. coronary arteries and aorta.

hemotamponade in postinfarction heart rupture

Such symptoms increase within a few minutes, after which death occurs from a heart rupture - the pupils do not react to light, breathing and heartbeat are not detected, consciousness is absent. The ECG at this moment will show an isoline, that is, a complete absence of cardiac activity.

Myocardial damage does not occur imperceptibly, and the risk of dying from a heart rupture increases significantly if a large-focal transmural infarction is diagnosed, especially against the background of arterial hypertension, in the elderly patient.

Internal ruptures are no less dangerous than external ones. So, violation of the integrity of the papillary muscles of the left ventricle is fraught with rapid development pulmonary edema - the main complication in violation of the movement of blood in the left half of the heart. Significant ventricular septal defects are manifested by symptoms of increasing. There is practically no chance to save the patient in these cases.

Heart rupture treatment

Treatment of patients with cardiac rupture involves emergency cardiac surgery and intensive care. It is not always possible to provide everything on time necessary measures because death comes suddenly and very rapidly. In addition, the patient may be far from the cardiac surgery hospital, and the time for preparation and transportation is extremely limited.

Surgical operations that can be performed for heart ruptures:

• Sewing up the defect and installing special “patches”;
• Coronary artery bypass grafting;
• Valve prosthetics;
• Donor organ transplant.

Surgical treatment consists in suturing the myocardial defect during open surgery, possibly strengthening the injury site with a special “patch” made of synthetic materials. In case of ruptures of the interventricular wall, their correction by endovascular intervention is applicable, without open access to the heart, but even in this case, a “patch” is established in the damage zone. Fluid from the pericardial cavity is removed by puncture.

With a deep atherosclerotic lesion of the coronary vessels, plastic surgery on the heart can be supplemented, aimed at restoring blood flow and, thus, accelerating the formation of a scar at the site of ischemia and rupture.

If the pathology is accompanied by damage to the papillary muscles, chords, and other elements of the valvular apparatus of the heart, then the method of choice may be the operation to install an artificial valve ().

Large gaps against the background of extensive heart attacks are extremely difficult to “correct” due to severe ischemia in the focus of necrosis, where the tissues are poorly connected to each other, regeneration slows down, and a significant area of ​​​​the heart muscle may be subject to removal. In these cases, the patient is able to save, but serious difficulties with its implementation are due to the limited time and lack of a suitable donor.

Drug therapy is aimed at maintaining acceptable blood pressure figures and the function of vital organs. The appointment of diuretics, peripheral vasodilators, analgesics, cardiac glycosides is shown. Infusion therapy consists in the introduction of fresh frozen plasma, saline solutions.

Rupture of the heart is a pathology that requires emergency medical care, so patients suffering from or who have had a myocardial infarction should not only carefully observe the regimen and appointments of a cardiologist, but also take seriously every attack of retrosternal pain, and if it lasts more than five minutes, then apply for medical care should be immediate.