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Broken heart: causes, symptoms, dangers

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Broken heart: causes, symptoms, dangers

What is heartbreak?

A rupture of the heart literally consists of tearing the heart tissue, one of the heart chambers (atria or ventricles) or the walls that separate them.

The prognosis depends on several factors and improves in the case of:

  • timely medical therapy (in case of a heart attack),
  • availability in the hospital structure of a cardiac surgery department.

Unfortunately it is a particularly serious condition, sadly characterized by a still very high mortality rate (still a month after the rupture).

What is it caused by?

The most common cause of myocardial rupture, fortunately a rare condition, is a recent myocardial infarction; rupture is a possible, albeit rare, complication, which can typically occur three to five days after the event (in some cases even later). The heart tissue, weakened by the heart attack, can break when the heart exercises its function as a pump by muscular contraction.

Other possible causes of breakage include:

However, the number of recorded episodes of myocardial rupture has decreased since aggressive infarction therapy has been intervened (although more specifically it also depends on the type of approach chosen).

Risk factors

The main risk factors include:

  • female sex,
  • old age,
  • delay in heart attack therapy (for example, waiting to go to hospital)
  • underweight.

When it represents a complication of a heart attack, heart rupture is also more common during the first episode.

Symptoms

Heart rupture symptoms may include

In the most severe cases, cardiogenic shock develops rapidly, a condition during which the heart suddenly becomes unable to pump enough blood to meet the needs of the body (especially the noble organs such as the brain and kidneys).

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However, it is often characterized by an almost sudden death, with no anticipatory symptoms.

What if your heart breaks?

The consequences depend on the location of the break:

  • A tear in the wall that separates the heart’s two lower chambers (ventricles) results in too much blood flowing to the lungs, causing a buildup of fluid (pulmonary edema) and shortness of breath or even respiratory failure.
  • A rupture of the mitral valve (the valve that separates the left atrium and ventricle of the heart) quickly causes heart failure (inability to pump blood around the body) as the blood starts flowing backwards.
  • A rupture in the free (outer) wall of the heart, the most common type of rupture, is usually fatal as blood travels out of the heart and into the chest.

How do you recognize it?

As the patient’s condition worsens, the doctor may hear an abnormal noise while listening to the patient’s chest (murmur); at that point one or more instrumental insights may be required:

Depending on the type of rupture, radiography can also be helpful, for example being able to highlight an enlarged left ventricle and pulmonary edema.

Treatment

The treatment of myocardial rupture is chronologically distinguishable in two phases:

  1. life support in the immediate context of the emergency,
  2. surgical correction of the rupture, if possible (not necessarily urgently, in some cases it may be preferable to delay to allow the heart to heal by offering tissues that are more resistant to repair). Traditional surgery or the less invasive percutaneous approach may be evaluated, depending on the experience of the cardiac surgeon and the type of lesion.
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Prognosis

The prognosis largely depends on the location of the rupture, as well as its size:

  • A rupture of an external wall is usually fatal, because it leaves no time for intervention.
  • A break in the wall separating the lower chambers (ventricles) often leaves room for repair surgery, albeit with a high mortality rate.
  • Ultimately, mitral valve rupture is probably the most likely event for successful surgical repair.

Sources and bibliography

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