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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 [1]
- 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
Special laboratory:
- emergency echocardiogram
Differential diagnosis:
- papillary muscle dysfunction
Management:
- afterload reduction with nitroprusside, diuretics
- stabilize with intra-aortic balloon pump
- consult cardiology, cardiac surgery [1]
Related
papillary muscle
General
heart disease (cardiac disease)
rupture
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15,
16, 17, 18. American College of Physicians, Philadelphia 1998, 2006,
2009, 2012, 2015, 2018
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022