Rupture of the Heart

SINCE the first description of rupture of the heart by William Harvey in 1647, this dramatic termination of life has attracted the attention of clinicians and pathologists alike. The anatomist Morgagni,' whose own life ended at the age of 79 with this disease, collected 10 cases in 1765. By 1928, 734 cases had been culled from the world literature by Davenport2 and subsequently many more reviews and case reports have been added.3-5 At the present time, there are conflicting factors that tend to alter the relative incidence of rupture of the heart. On one hand, with increased awareness and diagnostic facility in the recognition of acute myocardial infarction, one might expect the over-all incidence of rupture as well as other fatal complications to be reduced. On the other hand, because of the improved outlook for the acutely ill patient, shielded from fatal arrhythmias and cardiac standstill by pharmacologic or electrical stabilization, sustained in shock with vasopressors, and protected from thromboembolism by anticoagulants, the relative incidence of cardiac rupture among fatal cases might increase. In order to determine whether there is a notable change in incidence of rupture and to re-evaluate underlying factors, the consecutive autopsy series of three hospitals were reviewed over a period of 13 years.*