Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2006, 150(2):293-297 | DOI: 10.5507/bp.2006.045

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

Martin Hutyra^a, Tomas Skala^a, Dan Marek^a, Petr Nemec^b, Martin Sluka^c, Jiri Ostransky^c, Marek Richter^c, Jan Lukl^c

^a 1st Department of Internal Medicine, University Hospital, Olomouc, Czech Republic

^b Department of Cardiovascular Surgery, University Hospital, Olomouc

^c 1st Department of Internal Medicine, University Hospital, Olomouc

Background: 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 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.

Keywords: Acute myocardial infarction, Mitral regurgitation, Papillary muscle rupture, Cardiogenic shock

Received: October 19, 2006; Accepted: November 9, 2006; Published: December 1, 2006  Show citation