Pseudo-endocarditis secondary to ruptured posteromedial papillary muscle with anatomical variation: A Case Report

2020 ◽  
pp. 179
Author(s):  
Keyword(s):  
Myocardial Infarction ◽  
Mitral Valve ◽  
Papillary Muscle ◽  
Anatomical Variation ◽  
Low Grade ◽  
Papillary Muscle Rupture ◽  
Atypical Chest Pain ◽  
Anatomical Variant ◽  
Muscle Rupture ◽  
Mitral Valve Vegetation

Myocardial infarction is the leading cause of papillary muscle rupture. This complication occurs in up to 5% of cases post MI and although rare, it constitutes a cardiac emergency if left untreated. On this basis, a 59-year-old male presented with low-grade fever and atypical chest pain with raised inflammatory markers and troponin levels. He was treated for infective endocarditis after echocardiography revealed a mass on the mitral valve, which was presumed to be a mitral valve vegetation and so he completed a 6-weeks course of antibiotics followed by elective mitral valve replacement surgery. During surgery, it was discovered that there was no endocarditis. Instead an unusually small muscle head of one of the posteromedial papillary muscle groups had ruptured secondary to an inferior myocardial infarction. This ruptured muscle head was highly mobile and mimicked a mitral valve vegetation. The mitral valve was successfully repaired, and the right coronary artery grafted. He made a full recovery but developed new-onset atrial fibrillation for which he is awaiting elective cardioversion. One should have a high index of suspicion for diagnosing papillary muscle rupture as it may mimic valvular vegetation on echocardiography, especially if the papillary muscle involved is an anatomical variant.

Abstract 14887: Look Beyond the Coronaries: A Rare Cause of Acute Papillary Muscle Rupture

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Calvin M Kagan ◽  
Benjamin Kenigsberg ◽  
Gaby WEISSMAN ◽  
Mark Hofmeyer ◽  
Samer S Najjar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Invasive Mechanical Ventilation ◽  
Lv Function ◽  
Papillary Muscle Rupture ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Muscle Rupture

A 63-year-old male with numerous cardiac risk factors presented with two hours of rapidly progressing chest pain and shortness of breath. Exam was notable for respiratory distress requiring non-invasive mechanical ventilation and a holosystolic apical murmur radiating to the axilla. He had an elevated troponin and an electrocardiogram with anteroseptal ST depressions. He was diagnosed with a non-ST segment elevation acute coronary syndrome and taken for cardiac catheterization. Surprisingly, no occlusive epicardial disease was discovered. Left ventriculogram revealed engorgement of the left atrium and pulmonary arteries suggestive of severe mitral regurgitation. The mechanism of mitral regurgitation was unclear until transesophageal echocardiography showed a ruptured posteromedial papillary muscle with flail mitral valve, a picture classically caused by myocardial infarction. Cardiac MRI demonstrated preserved LV function with minor inferior apical hypokinesis, nonspecific endocardial late gadolinium enhancement in the inferior segments, and a small LV thrombus. An embolic myocardial infarction targeting a small territory involving posteromedial papillary muscle was thought most probable. The patient then underwent an uneventful mitral valve replacement and recovery. However, he returned two months later with severe biventricular dysfunction and cardiogenic shock with peripheral eosinophilia. Myocardial biopsy confirmed the diagnosis of eosinophilic myocarditis. An exhaustive workup for the etiology of his eosinophilia proved unrevealing; he was consequently diagnosed with the idiopathic subtype. The case highlights a rare but important clinical entity that has a varied phenotype. Our patient presented atypically with an acute papillary muscle rupture that mimicked an acute myocardial infarction, ultimately delaying diagnosis. As evidenced by our case, clinical suspicion of myocarditis should be high in all patients presenting with typical anginal symptoms with mechanical or circulatory compromise in the absence of acute coronary occlusion.

scholarly journals Papillary muscle rupture due to acute myocardial infarction followed by cardiogenic shock, pulmonary edema, and acute renal failure

2005 ◽  
Vol 62 (3) ◽  
pp. 235-241 ◽  
Author(s):  
Radoje Ilic ◽  
Zoran Trifunovic ◽  
Svetislav Tisma ◽  
Andjelka Ristic-Andjelkov ◽  
Milic Veljovic
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Surgical Treatment ◽  
Mitral Valve ◽  
Cardiogenic Shock ◽  
Papillary Muscle ◽  
Papillary Muscle Rupture ◽  
Muscle Rupture

Aim. The case of successful surgical treatment of anterolateral papillary muscle rupture due to acute myocardial infarction with cardiogenic shock, pulmonary edema and acute renal failure. Case report. A 62-year old male from Belgrade with chest pain, hypotension and a new heart murmur refused hospitalization at the Military Medical Academy. On the third day of his illness he was readmitted to MMA as an emergency due to hemoptysis. Examination revealed mitral valve anterolateral papillary muscle rupture. The patient, with signs of cardiogenic shock and acute renal failure, was immediately operated on. The surgery was performed using extracorporeal circulation. An artificial mitral valve was implanted, and myocardial revascularization accomplished with one venous graft of the left anterior descending artery. On the second postoperative day, hemodialysis was carried out due to acute renal failure. On the 28th postoperative day, the patient was discharged from the hospital being hemodynamically stable with normal renal function and balanced anticoagulation. The case is interesting in terms of unrecognized papillary muscle rupture that led to the development of cardiogenic shock, hemoptysis and acute renal failure. Conclusion. Papillary muscle rupture is a fatal complication of acute myocardial infarction. Early recognition and urgent surgical intervention were lifesaving in the case of complete papillary muscle rupture. Surgical treatment, regardless of high risk, is the procedure of choice.

scholarly journals Mitral valve repair for post-myocardial infarction papillary muscle rupture

2013 ◽  
Vol 44 (6) ◽  
pp. 1063-1069 ◽  
Author(s):  
W. Bouma ◽  
I. J. Wijdh-den Hamer ◽  
T. J. Klinkenberg ◽  
M. Kuijpers ◽  
A. Bijleveld ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Papillary Muscle ◽  
Post Myocardial Infarction ◽  
Valve Repair ◽  
Papillary Muscle Rupture ◽  
Muscle Rupture
Sign in / Sign up

Export Citation Format

Share Document