Cardiac laceration and pericardial tamponade due to cardiopulmonary resuscitation after myocardial infarction.

Complications of cardiopulmonary resuscitation (CPR), such as rib fractures and pneumothorax, are not uncommon. The authors report the case of a 69-year-old woman who underwent surgery for a perforated duodenal ulcer. Eighteen hours postoperatively she sustained a cardiac arrest; vigorous resuscitation efforts, using advanced cardiac life-support procedures, failed. At autopsy, she had 350 mL of fresh blood in her pericardial sac, which had caused cardiac tamponade. Three ribs were fractured at the left sternal border. Directly underneath the fractured ribs were a 0.4-cm laceration of the pericardium and an accompanying 0.7-cm laceration of the left ventricle. There was an acute thrombus in the left anterior descending artery. Microscopic examination of the heart showed acute infarction of the left ventricle in the vicinity of the laceration. This case demonstrates that vigorous CPR performed on an acutely infarcted heart can result in lethal cardiac laceration and tamponade.