When ventricular free wall rupture after acute myocardial infarction is not followed
by sudden death, it is referred to as subacute ventricular rupture. The sensitivity
and specificity of clinical, hemodynamic and echocardiographic diagnostic variables
obtained at bedside are unknown and were therefore prospectively studied in 1,247
consecutive patients with acute myocardial infarction including 33 patients with subacute
ventricular rupture diagnosed at operation (group A) and 1,214 patients without ventricular
rupture (at operation, postmortem study or at discharge) (group B). The incidence
of syncope, recurrent chest pain, hypotension, electromechanical dissociation, cardiac
tamponade, pericardial effusion, high acoustic intrapericardial echoes, right atrial
and right ventricular wall compression identified in two-dimensional echocardiograms
and hemopericardium demonstrated during pericardiocentesis was higher in group A than
in group B (p less than 0.00001). The presence of cardiac tamponade, pericardial effusion
greater than 5 mm, high density intrapericardial echoes or right atrial or right ventricular
wall compression had a high diagnostic sensitivity (greater than or equal to 70%)
and specificity (greater than 90%). The number of false positive diagnoses was always
high for each diagnostic variable alone (greater than 20%), but the combination of
clinical (hypotension), hemodynamic (cardiac tamponade) and echocardiographic variables
allowed a sensitivity of greater than or equal to 65% with a small number of false
positive diagnoses (less than 10%) and provided useful information for therapeutic
decisions. The diagnosis of subacute ventricular rupture requires a surgical decision.
Twenty-five (76%) of the 33 patients with subacute ventricular rupture survived the
surgical procedure and 16 (48.5%) are long-term survivors. Thus, subacute ventricular
wall rupture is a relatively frequent complication after acute myocardial infarction
that can be accurately diagnosed and successfully treated.