Clinical significance of intramyocardial dissecting hematoma after MI: A review

Intramyocardial dissecting hematoma (IDH) is a rare and catastrophic complication of myocardial infarction (MI) associated with high mortality and poor prognosis. Caused by hemorrhagic dissection between spiral myocardial fibers, IDH forms a blood-filled cavity that differs from complete cardiac rupture in that it preserves the integrity of the myocardial wall and is classified as a subtype of subacute cardiac rupture. Clinical manifestations vary according to the degree of impact on cardiac structure and hemodynamics. Echocardiography and cardiac magnetic resonance are essential in the diagnosis and assessment of IDH. Optimal management strategies for this rare complication of MI have not been established, and the ongoing debate about pharmacological versus surgical interventions requires multidisciplinary discussion to determine personalized treatment plans. Given the diagnostic and therapeutic challenges of IDH, there is an urgent need for clinicians to increase their understanding in order to improve diagnostic and therapeutic capabilities. This review aims to discuss the pathophysiological mechanisms, symptoms, diagnosis, treatment and prognosis strategies of IDH after MI.