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Mechanical complications of acute myocardial infarction

Roger J Laham, MD
Michael Simons, MD
Rakesh M Suri, MD, DPhil
Section Editor
Freek Verheugt, MD, FACC, FESC
Deputy Editor
Gordon M Saperia, MD, FACC


There are three major mechanical complications of acute myocardial infarction (MI): rupture of the left ventricular free wall; rupture of the interventricular septum; and the development of mitral regurgitation. One study compared 225 patients who had a first MI and experienced one of these complications to 1012 patients with a first MI without these mechanical complications [1]. Delayed hospitalization (≥24 hours), undue in-hospital physical activity, and postinfarction angina increased the risk of rupture in predisposed patients.

The clinical issues related to these mechanical problems, each of which can result in cardiogenic shock, will be reviewed here. (See "Clinical manifestations and diagnosis of cardiogenic shock in acute myocardial infarction".)

In this topic MI will refer to ST elevation MI, unless otherwise indicated.


Acute or subacute myocardial rupture is a serious and often lethal complication of ST elevation myocardial infarction (STEMI) [2].

Incidence — Rupture of the free wall of the infarcted ventricle is a relatively common finding in patients dying with an acute myocardial infarction (MI). Several large studies have found cardiac rupture in 14 to 26 percent of such patients (picture 1) [3,4]. The incidence is much lower when all patients with acute MI are considered. As an example, the National Registry of Myocardial Infarction published data on 350,755 patients in 1996 [5]. The following observations were noted:

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Literature review current through: Nov 2017. | This topic last updated: Jun 09, 2017.
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