ACUTE SEVERE MITRAL REGURGITATION WITH CARDIOGENIC SHOCK CAUSED BY TWO-STEP COMPLETE ANTERIOR PAPILLARY MUSCLE RUPTURE DURING ACUTE MYOCARDIAL INFARCTION

Martin Hutyra, Tomas Skala, Dan Marek, Petr Nemec, Martin Sluka, Jiri Ostransky, Marek Richter, Jan Lukl
2006 Biomedical Papers of the Faculty of Medicine of Palacky University  
Rupture of a papillary muscle is an infrequent but often fatal mechanical complication of acute myocardial infarction. Aim: The aim of this paper is to present a case report of a 65-year old women with acute severe mitral regurgitation with cardiogenic shock caused by two-step complete anterior papillary muscle rupture during acute myocardial infarction. The transthoracic echocardiography was obtained at the bedside and showed a posterior mitral valve prolapse with a severe mitral
more » ... itral regurgitation. During this examination the patient developed acute pulmonary oedema and a consequent cardiogenic shock. Transthoracic echocardiography was then reevaluated and completed. New findings of bi-leaflet mitral flail and progression of massive mitral regurgitation were documented. The complete rupture of a papilary muscle was then considered as a cause of an acute clinical deterioration. Intraoperative findings showed a complete transection of both heads of anterolateral and necrotic regions of basis of posteromedial papillary muscle. Conclusions: This case confirms the importance of immediate echocardiography in confirming a diagnosis of acute mechanical complications of acute coronary syndromes and this examination is important for the management of a hemodynamically unstable patient. Echocardiography should be done immediately on any patient in whom the diagnosis of mechanical complication of acute coronary syndromes is suspected.
doi:10.5507/bp.2006.045 pmid:17426796 fatcat:jee46mee6fcwjbbstzzp3ii5we