Infarction and Rupture of the Heart

To the Editor: Drs. Greenberg and Gitler must be commended for their lucid description of a case of ventricular rupture complicating myocardial infarction (Sept. 1 issue).¹ The accompanying editorial by Dr. Fox,² however, disparages the observation of obliteration of the “y” descent, labeling it “of pathophysiologic interest but not of practical diagnostic value.” He goes on to recommend echocardiography as the investigation of choice in this situation. In case of an unsatisfactory study he suggests pericardiocentesis as the next step. An echocardiogram demonstrating pericardial fluid is not diagnostic of tamponade. Furthermore, as in the case described in the Journal.