Ventricular Rupture

Overview

Ventricular rupture is a tear in the muscular wall of one of the heart's lower pumping chambers, the ventricles. It is most often a complication of a heart attack, when a section of heart muscle dies from lack of blood flow and becomes weak and fragile. The damaged area can then tear under the pressure of each heartbeat.

This is a rare but devastating event. Depending on where the tear occurs, blood may leak into the sac surrounding the heart, the wall between the chambers may break, or a muscle controlling a heart valve may give way. All of these cause the heart to fail rapidly. Ventricular rupture is a life-threatening emergency that requires immediate hospital care and, in most cases, emergency surgery.

Symptoms

Symptoms usually appear suddenly and worsen within minutes. They often occur in someone recovering from a recent heart attack.

• Sudden, severe chest pain or a feeling of pressure
• Extreme shortness of breath
• Rapid drop in blood pressure with dizziness or fainting
• Cold, clammy, pale skin
• Racing or irregular heartbeat
• Sudden collapse or loss of consciousness
• Signs of shock, such as confusion and weak pulse

Ventricular rupture is a medical emergency. Call emergency services immediately for sudden severe chest pain, collapse, or rapid breathing difficulty, especially in someone who has recently had a heart attack.

Causes

The most common cause is a heart attack that has weakened a portion of the heart muscle. As the dead tissue softens in the days afterward, it can tear. Specific situations include:

• Free wall rupture: the outer wall of the ventricle tears, allowing blood to fill the sac around the heart and compress it.
• Septal rupture: the wall between the two ventricles tears, mixing blood between chambers.
• Papillary muscle rupture: a small muscle that anchors a heart valve breaks, causing sudden severe valve leakage.

Less common causes include chest trauma, infection of the heart muscle, or a heart procedure complication. A first-time, large heart attack treated late carries the greatest risk.

Risk Factors

Risk is highest in the first several days after a major heart attack. Factors that increase the chance of rupture include:

• A large heart attack, especially a first heart attack
• Delayed treatment of a heart attack
• Older age
• High blood pressure
• Female sex
• No prior history of chest pain (no protective collateral blood vessels)

Diagnosis

Because the situation is critical, diagnosis is rapid and often done at the bedside. Tools include:

• Echocardiogram: an ultrasound of the heart that can quickly show fluid around the heart, a hole between chambers, or a torn valve support.
• Electrocardiogram (ECG): shows the underlying heart attack and rhythm changes.
• Blood tests: cardiac enzymes confirm heart muscle injury.
• Physical examination: a new heart murmur, low blood pressure, and signs of shock raise suspicion.
• CT or cardiac catheterization: may be used when the patient is stable enough to define the problem before surgery.

Treatment

Ventricular rupture is treated as an emergency, usually with surgery. Care typically involves:

• Emergency stabilization: supporting blood pressure, oxygen, and circulation, sometimes with medications or mechanical support devices.
• Draining fluid around the heart: a needle or tube may be used to relieve dangerous compression of the heart.
• Surgical repair: open-heart surgery to repair or patch the torn wall, close a septal defect, or repair or replace a damaged valve.
• Treating the underlying heart attack: restoring blood flow to the heart muscle through stenting or bypass when appropriate.

Even with treatment, ventricular rupture is very serious. Survival depends on how quickly the problem is recognized and repaired.

Prevention

The best prevention is rapid, effective treatment of a heart attack and good long-term heart care. Steps that lower risk include:

• Seeking emergency care at the first signs of a heart attack, such as chest pressure, arm or jaw pain, and breathlessness
• Early treatment to reopen blocked arteries, which limits the amount of muscle damage
• Controlling high blood pressure
• Close monitoring in the hospital during the high-risk days after a heart attack
• Following prescribed heart medications and cardiac rehabilitation after recovery

When to See a Doctor

Call emergency services immediately for any of the following, particularly within days of a heart attack:

• Sudden severe chest pain or pressure
• Sudden, severe shortness of breath
• Fainting, collapse, or feeling about to pass out
• Cold, clammy, pale skin with a rapid or weak pulse

Do not drive yourself. These are signs of a heart emergency that needs immediate professional care.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Heart attack — Symptoms and causes.
2. MedlinePlus, U.S. National Library of Medicine. Heart attack.
3. American Heart Association. Complications of a heart attack.
4. National Heart, Lung, and Blood Institute (NHLBI). Heart Attack.