Too dangerous! What are the clinical characteristics of heart vessel rupture?

The heart is one of the most important organs in the human body. Once the heart is damaged, the person may not live long, especially in the case of severe trauma. A ruptured heart vessel is no joke! What are the obvious clinical symptoms of a ruptured heart vessel?

Clinical manifestations

If the heart bleeds and the pericardial rupture remains open, blood will gush out of the chest wound or flow into the pleural cavity. Clinical signs of hypovolemia appear: pale complexion, weak breathing, tachycardia, decreased blood pressure, etc. The patient may quickly fall into shock and die from massive bleeding. The injured person presents with shock, chest pain, rapid breathing, fast heart rate, weak heart sounds, fast pulse rate, small pulse volume, low blood pressure, distended jugular vein, and increased venous pressure. Emergency treatment should be carried out immediately based on the history of trauma and the above signs. Although fresh blood can be drawn out by pericardial puncture to make a clear diagnosis and temporarily relieve the symptoms of cardiac compression, about 25-40% of the injured are blocked by blood clots and cannot draw blood. Puncture may also cause damage to the coronary artery branches. After the injured with a ruptured heart are sent to the hospital, they should only undergo multiple pericardiocentesis to treat the hemopericardium, with a mortality rate of more than 60%. However, if a thoracotomy is performed immediately after a clear diagnosis of pericardiocentesis and the heart rupture is repaired, the mortality rate can be reduced to less than 20%. During the operation, blood volume should be supplemented and shock should be corrected. If the heart ruptures and is complicated by massive hemothorax, the pressure on the heart is relatively light, and the pleural cavity can be drained first while replenishing the blood volume. If bleeding continues and the amount of pleural cavity drainage is large, thoracotomy should be performed as soon as possible.

Causative factors

(1) Gender and age. Heart rupture often occurs in elderly women, with the incidence in women being four times that in men. It often occurs in patients over 60 years old. Foreign literature reports that most cases occur in patients over 70 to 80 years old, which may be related to the thinner and more fragile ventricular wall of the elderly.

(2) Hypertension. In the acute stage of myocardial infarction, if blood pressure continues to rise to above 20/12 kPa (150/90 mmHg), it is prone to rupture. The incidence of heart rupture is three times that of people with normal blood pressure.

(3) Rupture often occurs in the first acute transmural myocardial infarction. The patient has no obvious history of angina pectoris or heart failure. Sudden coronary artery thrombosis or severe coronary artery spasm, without sufficient collateral circulation, often leads to a through-going transmural myocardial infarction. This type of first myocardial infarction usually does not have myocardial ischemia or old scar tissue as a scaffold, and the non-infarcted myocardial contraction function is better. When the surrounding myocardium contracts, it cuts the necrotic myocardium, making it prone to rupture.

(4) Heart rupture almost never occurs in myocardium with good collateral circulation. Because collateral circulation protects the subepicardial myocardium, even if acute coronary artery blockage occurs, leading to acute myocardial infarction, it may be limited to the subendocardial myocardium, or abnormal Q waves may appear, and the R wave may only become smaller but not disappear. By protecting the subepicardial myocardium, the heart shape does not expand outward, thus preventing heart rupture.