papillary muscle rupture

Etiology

• inferior wall myocardial infarction

Epidemiology

• most common complication of inferior wall MI resulting in cardiogenic shock

Pathology

• mitral regurgitation
• pulmonary edema

Clinical manifestations

• generally occurs after 3-7 days, but may occur later
  • mitral regurgitation
    • loud holosystolic murmur, thrill
    • diastolic rumble in cases of large regurgitant volume
    • murmur may be faint or inaudible with complete papillary muscle rupture
    • elevated pulmonary capillary wedge pressure with large V waves
    • normal right atrial pressure
    • pulmonary edema
    • cardiogenic shock

Diagnostic procedures

• emergency echocardiogram

Differential diagnosis

• papillary muscle dysfunction

Management

• afterload reduction with nitroprusside, diuretics
• stabilize with intra-aortic balloon pump
• consult cardiology, cardiac surgery

More general terms

• heart disease (cardiac disease)
• rupture

Additional terms

• papillary muscle