Myocardial Rupture

What is heart rupture?

Heart rupture is a heart attack complication in which your heart’s walls, muscles or valves come apart. It can occur during a heart attack or the first month after a heart attack. Most of the time, it happens in the first five to 10 days after a heart attack.

Who does heart rupture affect?

A heart rupture can occur if a heart attack causes a lot of damage to your heart. Heart rupture is more likely to affect people who:

• Were assigned female at birth.
• Have high blood pressure.
• Have chest pain that keeps coming back.
• Wait a long time after the chest pain starts before going to the hospital.
• Are having their first heart attack.
• Are older than 60.
• Have atherosclerosis in several blood vessels.
• Have heart failure.
• Had a stroke.
• Have chronic kidney disease.

How common is heart rupture?

One study found that about 30% of people who had a heart attack and sudden death also had a myocardial rupture.

Between 10% and 20% of people who have a heart attack have a rupture in their left ventricular free wall (outer wall of the heart). The left ventricle is the lower chamber of your heart that pushes blood out to your aorta, which takes it to your whole body.

Less than 0.4% of people who have a heart attack have a rupture in the wall between their ventricles, or lower heart chambers.

What happens with a ruptured heart?

It depends on where the rupture occurs.

• A rupture in the wall (septum) between your two lower heart chambers (ventricles) allows an excess of blood to go to your lungs. This causes a fluid buildup in your lungs (edema) and shortness of breath or respiratory failure. A rupture in your mitral valve muscle quickly causes heart failure because the blood starts leaking backward and isn’t pumped out to the body normally
• A rupture in your free (outer) heart wall, the most common type of rupture, is usually fatal as blood moves outside of the heart and into the chest.

What are the symptoms?

Heart rupture symptoms may include:

• Chest pain.
• Cardiogenic shock.
• Cardiac arrest.
• Heart failure.
• Pulmonary edema or respiratory failure
• Cardiac tamponade.

What causes heart rupture?

When a heart attack injures your heart muscle, it weakens it. In rare cases, the force of your pumping heart can cause a rupture or tear in a weak area of your heart.

How is heart rupture diagnosed?

Your healthcare provider will listen to your heart and order tests. They may hear a murmur through their stethoscope.

What tests will be done to diagnose heart rupture?

Your healthcare provider will most likely do a transthoracic echocardiogram (TTE). If they need more information, they can do other tests, such as:

• Transesophageal echocardiogram (TEE).
• Cardiac catheterization.
• CT scan.
• Heart MRI.

How is a ruptured heart treated?

Medicines can help temporarily, but surgery is the best treatment for a myocardial rupture. Depending on your condition, your provider may need to do surgery right away or help you with temporary mechanical devices until surgery day.

Since the risk of death from surgery to fix a ruptured ventricle wall is lower when waiting seven days, providers prefer to wait if they can. This allows the muscle to heal enough that stitches will hold and allow for a good repair. However, if you’re not in a stable condition, it’s risky to wait to do surgery because the tear can get worse.

Your provider and your family may need to discuss the pros and cons of the various treatment options and decide what’s best for your situation.

What medications/treatments are used?

Heart rupture treatments include:

• Diuretics.
• Inotropes.
• Vasodilators.
• ECMO.
• Intra-aortic balloon pump to help your heart pump blood.
• Left ventricular assist device.
• Minimally invasive (through a blood vessel) closure of a rupture.
• Open-heart surgery to patch a rupture.

Surgery, the preferred treatment for myocardial rupture, is risky. However, you can live many years after a successful surgery.

How can I reduce my risk?

If you’re having a heart attack, get help quickly. This will improve your chances of surviving a heart attack and avoiding complications like heart rupture. Never wait to be evaluated if you think you may be having a heart attack as time is of the essence.

What can I expect if I have a heart rupture?

Your prognosis depends on which part of your heart has a rupture.

• If you have a ruptured heart wall (the outer or free wall), it’s usually fatal. This is because there’s not enough time to make a surgical repair. If your provider attempts a repair, it normally doesn’t work.
• If the wall between the two lower chambers (ventricles) of your heart ruptures, your provider may be able to fix it with surgery. However, this surgery has a 43% mortality rate, which is higher than any other kind of heart surgery.
• If your rupture occurs in your mitral valve muscles, your provider may be able to do an operation to repair it.

Outlook for heart rupture

A heart rupture is serious. It’s fatal for half of the people who have it. Many of these deaths happen when people have sudden death outside of a hospital. Without surgery, your prognosis isn’t good.

After surgery, many people have complications such as bleeding or low cardiac output. However, people were doing well five years after surgery when researchers followed up with them.

Can you survive a ruptured heart?

Yes, you can survive a ruptured heart if you get a quick diagnosis and treatment. You can have a better survival rate after having open-heart surgery.

How do I take care of myself?

Go to all scheduled follow-up appointments with your healthcare provider. Be sure to take any medicines they prescribed for you. Get help right away if you think you’re having another heart attack.

What questions should I ask my doctor?

• Which part of my heart has a heart rupture?
• Which treatment is best for my situation?
• What’s the outlook for my specific case?

A note from Cleveland Clinic

If your loved one has a heart rupture, you may need to consider the risks and benefits of various treatments. Don’t be afraid to ask questions so you can get a better understanding of treatments and what they may or may not be able to do. If your loved one isn’t able to participate in these conversations, think about what they would want.