Echocardiography and detection of coronary artery disease

2021 ◽  
pp. 395-401
Author(s):  
Thor Edvardsen ◽  
Marta Sitges ◽  
Rosa Sicari
Keyword(s):  
Mitral Regurgitation ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Papillary Muscle Rupture ◽  
Non Invasive ◽  
Muscle Rupture ◽  
The Status ◽  
Acute Mitral Regurgitation ◽  
Artery Disease ◽  
Inducible Ischaemia

Non-invasive imaging modalities play an important role in the evaluation and management of patients with known or suspected coronary heart disease (CAD). This chapter will describe how we should use echocardiography in acute and chronic CAD at rest and during stress. In patients with established or suspected CAD, echocardiography provides useful information on the status of global and segmental myocardial function, the presence of functional mitral regurgitation and potentially of other signs of myocardial ischaemia. Echocardiography can be used to identify complications such as severe ventricular failure, acute mitral regurgitation, papillary muscle rupture, wall rupture, left ventricular (LV) thrombus, and cardiac tamponade. Inducible ischaemia is typically evaluated by stress echocardiography and will also be discussed in this chapter.

Mechanical complications of myocardial infarction

2018 ◽  
Author(s):  
José López-Sendón ◽  
Esteban López de Sá
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Thrombus Formation ◽  
Left Ventricular ◽  
Free Wall ◽  
Papillary Muscle Rupture ◽  
Mechanical Complications ◽  
Muscle Rupture

Mechanical complications after an acute infarction involve different forms of heart rupture, including free wall rupture, interventricular septal rupture, and papillary muscle rupture. Its incidence decreased dramatically with the widespread use of reperfusion therapies occurring in <1% of ST-elevation myocardial infarction patients, and mortality is very high if not properly diagnosed, as surgery is the only effective treatment (Ibanez et al, 2017). Echocardiography is the most important tool for diagnosis that should be suspected in patients with hypotension, heart failure, or recurrent chest pain. Awareness and well-established protocols are crucial for an early diagnosis. Modern imaging techniques permit a more reliable and direct identification of left ventricular free wall rupture, which is almost impossible to identify with conventional echocardiography. Mitral regurgitation, secondary to papillary muscle ischaemia or necrosis or left ventricular dilatation and remodelling, without papillary muscle rupture, is frequent after myocardial infarction and is considered as an independent risk factor for outcomes. Revascularization to control ischaemia and surgical repair should be considered in all patients with severe or symptomatic mitral regurgitation in the absence of severe left ventricular dysfunction. Other mechanical complications include true aneurysms and thrombus formation in the left ventricle. Again, these complications have decreased with the use of early reperfusion therapies and, for thrombus formation, with aggressive antithrombotic treatment. In a single large randomized trial (STICH), surgical remodelling of the left ventricle failed to demonstrate a significant improvement in outcomes, although it still may be an option in selected patients.

Partial Papillary Muscle Rupture: A Cause of Acute Mitral Regurgitation

2013 ◽  
Vol 345 (6) ◽  
pp. 478-481 ◽  
Author(s):  
Peter B. Flueckiger ◽  
Alan C. Cheng ◽  
Jonathan M. Patton ◽  
Stephen D. Clements ◽  
Stamatios Lerakis
Keyword(s):  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Papillary Muscle Rupture ◽  
Muscle Rupture ◽  
Acute Mitral Regurgitation

scholarly journals Diagnostic Pitfalls in Papillary Muscle Rupture-Associated Acute Mitral Regurgitation after Acute Myocardial Infarction

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Akiko Kameyama ◽  
Hiroshi Imamura ◽  
Hiroshi Kamijo ◽  
Kanako Takeshige ◽  
Katsunori Mochizuki ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Transthoracic Echocardiography ◽  
Heart Surgery ◽  
Systolic Murmur ◽  
Papillary Muscle Rupture ◽  
Muscle Rupture ◽  
Acute Mitral Regurgitation

Papillary muscle rupture (PMR) is a rare and fatal complication of acute myocardial infarction (AMI). We report a case of acute mitral regurgitation (MR) due to PMR with pulmonary edema and cardiogenic shock following AMI with small myocardial necrosis. An 88-year-old woman was brought to our emergency department in acute respiratory distress, shock, and coma. She had no systolic murmur, and transthoracic echocardiography was inconclusive. Coronary angiography showed obstruction of the posterior descending branch of the right coronary artery. Although the infarction was small, the hemodynamics did not improve. Transesophageal echocardiography established papillary muscle rupture with severe mitral regurgitation 5 days after admission. Thereafter, the patient and her family did not consent to heart surgery, and she eventually died of progressive heart failure. Physicians should be aware of papillary muscle rupture with acute mitral regurgitation following AMI in patients with unstable hemodynamics, no systolic murmur, and no abnormalities revealed on transthoracic echocardiography.

Acute mitral regurgitation after non-ischemic papillary muscle rupture: A case report

2021 ◽  
Author(s):  
Miho Nakamura ◽  
Akihiro Isotani ◽  
Kyohei Yamaji ◽  
Katsumi Inoue ◽  
Katsuhiro Kondo ◽  
...  
Keyword(s):  
Case Report ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Papillary Muscle Rupture ◽  
Muscle Rupture ◽  
Acute Mitral Regurgitation

Mechanical complications of myocardial infarction

2016 ◽  
Author(s):  
José López-Sendón ◽  
Esteban López de Sá
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Thrombus Formation ◽  
Left Ventricular ◽  
Free Wall ◽  
Papillary Muscle Rupture ◽  
Mechanical Complications ◽  
Muscle Rupture

Mechanical complications after an acute infarction include different forms of heart rupture, including free wall rupture, interventricular septal rupture, and papillary muscle rupture. Its incidence decreased dramatically with the widespread use of reperfusion therapies but may occur in 2–3% of ST-elevation myocardial infarction patients, and mortality is very high if not properly diagnosed, as surgery is the only effective treatment. Echocardiography is the most important tool for diagnosis that should be suspected in patients with hypotension, heart failure, or recurrent chest pain. Awareness and well-established protocols are crucial for an early diagnosis. Modern imaging techniques permit a more reliable and direct identification of left ventricular free wall rupture, which is almost impossible to identify with conventional echocardiography. Mitral regurgitation, secondary to papillary muscle ischaemia or necrosis or left ventricular dilatation and remodelling, without papillary muscle rupture, is frequent after myocardial infarction and is considered as an independent risk factor for outcomes. Revascularization to control ischaemia and surgical repair should be considered in all patients with severe or symptomatic mitral regurgitation in the absence of severe left ventricular dysfunction. Other mechanical complications include true aneurysms and thrombus formation in the left ventricle. Again, these complications have decreased with the use of early reperfusion therapies and, for thrombus formation, with aggressive antithrombotic treatment. In a single large randomized trial (STICH), surgical remodelling of the left ventricle failed to demonstrate a significant improvement in outcomes, although it still may be an option in selected patients.

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