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.