In nine of these cases there was no fracture, and either no bruise of the parietes or a very slight one.

The pericardium was intact in at least half of the cases, and in 22 in which the precise seat of lesion was noticed the right ventricle was ruptured in eight, the left in three, the left auricle in seven, the right in four.

The longest period during which any patient survived the injury was fourteen hours.
Among the older writers who note this traumatic injury are Fine, who mentions concussion rupturing the right ventricle, and Ludwig, who reports a similar accident.

Johnson mentions rupture of the left ventricle in a paroxysm of epilepsy.

There is another species of rupture of the heart which is not traumatic, in which the rupture occurs spontaneously, the predisposing cause being fatty degeneration, dilatation, or some other pathologic process in the cardiac substance.
It is quite possible that the older instances of what was known as "broken-heart," which is still a by-word, were really cases in which violent emotion had produced rupture of a degenerated cardiac wall.
Wright gives a case of spontaneous rupture of the heart in which death did not occur for forty-eight hours.