Papillary Muscle Rupture as a First Event in Acute Myocardial Infarction

Abstract. Cardiogenic shock caused by papillary muscle rupture in acute myocardial infarction is potentially reversible by surgical treatment. A case of inferior myocardial infarction in a 56-year-old previously healthy man is reported, in which the first event was papillary muscle rupture. The patient was in shock and had a mitral insufficiency murmur. The diagnosis was made by echocardiography and ventriculography. A St. Jude valve was implanted, and the patient was discharged in good health. It is suggested that routine echocardiography be carried out on patients with sudden cardiogenic shock, when a mitral murmur is present.     

Papillary Muscle Rupture Following Myocardial Infarction

Papillary muscle rupture is an uncommon, catastrophic complication of myocardial infarction that is potentially correctable if promptly diagnosed. Two cases are described in which the diagnosis of papillary muscle rupture was complicated by unusual initial presentations, absence of audible murmurs, and technically difficult, nondiagnostic transthoracic echocardiograms. In both cases, a high index of clinical suspicion for papillary muscle rupture led to transesophageal echocardiography and a rapid, definitive diagnosis. Since early surgery may be important in this disorder, a rapid, reliable diagnosis is essential and transesophageal echocardiography is the diagnostic procedure of choice.     

Papillary Muscle Rupture Following Non‐ST‐Elevation Myocardial Infarction: A Case Report

Papillary muscle rupture is a serious mechanical complication of acute myocardial infarction typically seen within 5–7 days following transmural ST‐elevation myocardial infarction. The incidence of papillary muscle rupture has markedly decreased in the modern era due to improved diagnosis and early coronary revascularization of ST‐elevation myocardial infarction. As a result, papillary muscle rupture is increasingly seen following non‐ST‐elevation myocardial infarction where both diagnosis and revascularization can be delayed. In this report, we describe two cases of papillary muscle rupture following delayed presentation of non‐ST‐elevation myocardial infarction and delayed recognition of papillary muscle rupture.     

Role of Echocardiography in Complications Associated with Partial or Complete Rupture of the Myocardium in Acute Myocardial Infarction

In this report, we focus on the specific complications of acute myocardial infarction that are associated with rupture of the myocardium and for which two-dimensional and Doppler color flow echocardiography expedites accurate diagnosis for prompt treatment, including surgical repair, which can be crucial to survival in such cases.     

Role of Papillary Muscle Dysfunction in the Pathogenesis of Mitral Regurgitation in Myocardial Infarction:

To elucidate the pathogenesis of mitral regurgitation (MR) after myocardial infarction (MI), the incidence of papillary muscle dysfunction (PMD), mitral annular size, and the extent of wall-motion abnormalities were examined in 81 patients with previous MI by two-dimensional echocardiography and real-time two-dimensional Doppler flow imaging. The prevalence of pathological MR was lower in patients with anterior MI (36%) than in those with inferior (65%) or anterior and inferior MI (88%) (P < 0.01 vs anterior MI group). The incidence of PMD in patients with MR in the anterior MI group (15%) was lower than that in the inferior (50%, P < 0.01) or anterior and inferior MI group (43%, P < 0.05). The mitral annular dimension in patients with MR was significantly greater than in those without MR, but it was similar among the three groups. The extent of wall-motion abnormality correlated significantly with the area of MR jet in the anterior MI group (y = 3.1x + 15.5, r = 0.52, P < 0.01) and in the inferior MI group (y = 8.3x + 32.7, r = 0.57, P < 0.01). However, the slope of this relationship was significantly steeper in the inferior MI group than in the anterior MI group (P < 0.05). These results indicated that the degree of MR with inferior MI was greater than with anterior MI for a given MI area. PMD may play an important role in the higher prevalence and greater degree of MR in inferior MI.     

Echocardiographic Assessment of Complications Related to Left Ventricular Function in Acute Myocardial Infarction

Three complications of acute myocardial infarction without myocardial rupture are directly associated to the function of the myocardium: papillary muscle dysfunction, congestive heart failure, and cardiogenic shock. In this article, the pathophysiological mechanism of each complication is discussed, and the contribution of echocardiography to diagnosis and management is reviewed.     

A Rare Clinical Entity: Ventricular Septal Rupture with Right Ventricular Wall Dissection after Inferior Myocardial Infarction

Right ventricular wall dissection following ventricular septal rupture related to inferior myocardial infarction has been reported in a few cases. In most of the cases, right ventricular wall dissection was diagnosed in postmortem studies. Herein, we present a 68-year-old man who had a ventricular septal rupture with right ventricular wall dissection after inferior myocardial infarction. Early recognition of this complication with bedside transthoracic echocardiography and prompt surgical repair are key to achieving survival in these patients.     

Subacute Rupture of the Free Left Ventricular Wall Following Acute Myocardial Infarction

ABSTRACT. In previously published cases of subacute or sealed postinfarction rupture of the free left ventricular wall, the patients presented a clinical picture of sudden shock and tamponade. Our patient, a 64-year-old man, suffered renewed chest pain on the fourth postinfarction day and went into cardiogenic shock, which was pharmacologically reversible. There were no bed-side signs of tamponade and the ECG showed the pattern of acute pericarditis, both features in contrast to previously reported cases in the literature. Echocardiography demonstrated localized fluid in the pericardial sac and a puncture revealed non-coagulating blood. The patient was successfully operated on. At surgery a small rupture sealed by blood clots was demonstrated in the infarcted inferior wall of the left ventricle.     

Echocardiographic Diagnosis of Subacute Ventricular Wall Rupture Complicating Acute Myocardial Infarction

Rupture of ventricular wall is one of the most threatening complications of acute myocardial infarction. As a rule, it is rapidly lethal, and a precise diagnosis is seldom possible. On the contrary, in the so-called subacute ruptures (about one third of all cases), patients can survive for several hours, allowing time for diagnosis and immediate surgical intervention. We report here the case of one patient with subacute cardiac rupture who was diagnosed with echocardiography and successfully treated with pericardiocentesis and surgery.     

Ventricular Septal Rupture Complicating Silent Myocardial Infarction

A 55-year-old gentleman presented to the emergency department with shortness of breath for the past 3 days. Cardiac magnetic resonance imaging assessed intracardiac shunting and a mechanism of ventricular septal rupture (VSR), showing significant left-to-right shunting and Qp:Qs of 4:1. There was transmural myocardial infarction as well as an aneurysm at the diaphragmatic inferior wall of the left ventricle.     

急性心肌梗死并发室间隔破裂的研究进展

急性心肌梗死后并发的室间隔破裂穿孔是一种少见但是非常严重的并发症，自然病程凶险。早期诊断、积极的内科治疗和外科手术可降低死亡率，改善预后。     

急性心肌梗死心脏破裂机制的研究进展

心脏破裂是急性心肌梗死(AMI)最严重的并发症之一,占AMI院内死因的20%～31%。现就目前AMI心脏破裂机制的研究现状和进展作一综述。新的观点认为,心肌重构缺陷可能会倾向于发生心脏破裂。基质金属蛋白酶系统在细胞外基质重构和心脏破裂中具有重要作用。肾素-血管紧张素系统及神经激素系统的激活、心肌细胞凋亡、基因易感性也可能参与了心脏破裂的发生。     

Lateral Left Ventricular Wall Rupture Following Acute Myocardial Infarction: Pathophysiological Interpretation by Multimodality Imaging Approach

Lateral left ventricular wall rupture (LVWR) is a rare complication following acute myocardial infarction (AMI) less than 1%. After cardiogenic shock, LVWR constitutes the most common cause of in‐hospital death in AMI patients. Around 40% of all LVWR occurred during the first 24 hours and 85% within the first week. In the present case, 76 hours following the intervention, LVWR was observed likely due to a small infarction at the lateral left ventricular wall possibly due to the marginal lesion. Our patient refused surgery and was followed clinically. Eighteen months later, real time three‐dimensional echocardiography showed a pseudoaneurysm.     

急性心肌梗死并发室间隔穿孔的研究及治疗进展

心肌再灌注疗法降低了急性心肌梗死并发室间隔穿孔的发病率 ,但是一旦发生穿孔 ,病人的恢复和存活仍然依赖于强有力的内科治疗和手术的介入。经皮穿刺介入封堵治疗作为治疗本病的一种新方法虽然尚存许多问题 ,但是其应用前景值得我们关注。