RUPTURE OF THE HEART IN PATIENTS IN MENTAL INSTITUTIONS

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Abstract
In a series of 115 consecutive autopsies of patients who died suddenly or unexpectedly in Mass. Mental Institutions 16, or 73%, of a total of 22 cases of acute myocardial infarction showed cardiac tamponade due to rupture of the heart wall at the, site of the recent infarct. Cardiac rupture was not found in any of the 25 cases in the same series with healed infarct only. The psychiatric diagnoses were dementia prae-cox in 6 cases, manic depressive psychosis in 2, paranoia in 2, alcoholic psychosis in 1, senile psychosis in 1, epilepsy in 1, imbecility in 1, organic disease of the C. N. S. in 1, and undiagnosed in 1. The mean age of the 16 persons whose hearts ruptured was 66.5 yrs., slightly less than 1 yr. older than the avg. age in Friedman and White''s series. Ten were [male][male] and 6 [female][female]. Fourteen of the 16 patients had shown a moderate to severe hypertension in past yrs. In only one case was there a definite history of angina pectoris. Ten of the patients were ambulatory and in apparent good health before their sudden collapse and death. Four patients had complained mildly and 2 of these received partial bed rest. The remaining 2 persons were incapacitated during the last 12 hrs. of life incident to the development of an extensive subepicardial hematoma. A definite antemortem diagnosis of myocardial infarction or cardiac rupture was not made in any of the cases. The acute myocardial infarct, through which the rupture occurred, was located in the left ventricle in 8 instances (anterior wall, 5, posterior wall, 2, lateral wall, 1), both left ventricle and interventricular septum were involved in 7 cases, and in the 16th case both ventricles and the intervening septum were included. Early fibrinous pericarditis was present in 10 and endocardial thrombosis in 9. The ruptures involved the left ventricular wall in 15 cases and the right in one. The estimated age of the responsible infarct was 2-4 days in 6 cases, 2-6 days in 3 cases, 1-2 wks. in 4 cases, 2-3 wks. in 2 cases, and not stated in the remaining case. This experience, in contrast to that in ordinary medical practice where it is possible to make early diagnoses and to institute adequate treatment, strongly supports the present approved therapy of bed rest during the first 3 wks. after the onset of acute myocardial infarction.

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