Cardiopulmonary resuscitation does not cause left ventricular rupture of the heart with acute myocardial infarction: a pathological analysis of 77 autopsy cases
Introduction
Cardiac rupture during acute myocardial infarction (AMI) is one of the most frequent causes of sudden cardiac death [1], [2], [3], [4]. It has been suggested that external cardiac massage of infarcted areas may lead to left ventricular rupture. In fact, a few reports of left ventricular rupture with AMI following cardiopulmonary resuscitation (CPR) have been reported [5], [6], [7], although generally rupture occurs spontaneously. To our knowledge, there has been no pathological study comparing cases of cardiac rupture during AMI with CPR to those without CPR. In the present study, therefore, we pathologically compared cases of cardiac rupture during AMI with and those without CPR, and morphologically evaluated whether cardiac rupture in fact occurred as a result of cardiopulmonary resuscitation in these cases.
Section snippets
Materials
We pathologically examined 77 patients who died suddenly of ventricular free wall rupture during AMI (51 men and 26 women; aged 47–94 years; mean age: 69.9 years) at our institutes (60 cases) and at the Department of Legal Medicine, Kitasato University School of Medicine (17 cases) between March 1996 and February 1998.
Diagnosis of myocardial infarction was established based on macro- and microscopic findings of the affected myocardium and on the existence of coronary plaque disruption with
Results
No significant differences were found between the CPR and the NCPR group in any of the investigated items (see Table 1, Fig. 1, Fig. 2).
Discussion
Previous reports have suggested that CPR, particularly external cardiac massage, in patients with AMI can result in rupture of the left ventricle [5], [6], [7]. In the present study, we show that CPR for patients with AMI did not cause left ventricular rupture. The evidence that CPR did not produce left ventricular rupture through the infarcted area were as follows.
First, there were no morphological differences in the left ventricular free wall rupture through the infarcted area between the
Acknowledgements
The authors wish to express their deep appreciation to the medical examiners at Tokyo Medical Examiner's Office and Professor Katsuyoshi Kurihara, Department of Forensic Medicine, Kitasato University School of Medicine, for their kind permission in letting us examine their cases. We also wish to express gratitude to the medical technologists at Tokyo Medical Examiner's Office and our department for their excellent technical assistance. This study was supported in part by a Grant-in-Aid from the
References (24)
- et al.
Rupture of the left ventricular free wall during acute myocardial infarction: analysis of 138 necropsy patients and comparison with 50 necropsy patients with acute myocardial infarction without rupture
Am J Cardiol
(1988) - et al.
Postinfarction rupture of the left ventricular free wall: clinicopathologic correlates in 100 consecutive autopsy cases
Hum Pathol
(1990) - et al.
Ill-effects of cardiac resuscitation: report of two unusual cases
Chest
(1975) - et al.
Complications of cardiac resuscitation
Am Heart J
(1975) - et al.
Left ventricular laceration due to stented prosthesis
Chest
(1980) Cardiac rupture due to myocardial infarction: a statistical study of autopsy cases in Tokyo Medical Examiner's Office
Res Pract Forensic Med
(1992)- et al.
Practical cardiovascular pathology
(1998) - et al.
Cardiopulmonary complications of external cardiac massage
Hawaii Med J
(1969) - et al.
Cardiac laceration and pericardial tamponade due to cardiopulmonary resuscitation after myocardial infarction
J Forensic Sci
(1991) - et al.
Cardiac tamponade. A study of 50 hearts
Eur J Cardiol
(1975)
The speed of healing of myocardial infarction. A study of the pathologic anatomy in seventy-two cases
Am Heart J
The ageing of cardiac infarcts, and its influence on cardiac rupture
Br Heart J
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