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Mitral Papillary Muscle Rupture

Ruptured Mitral Papillary Muscle


Presentation

  • She was presented to our hospital due to respiratory distress. On physical examination, an apical holosystolic murmur radiating to the axillary region was recognized.[ncbi.nlm.nih.gov]
  • An 86-year-old woman with a history of hypertension presented with acute onset of chest pain and evidence of shock (hypotension and tachycardia).[circ.ahajournals.org]
  • This latest revision presents updated clinical information and has eight new chapters, including obesity and metabolic syndrome, women and heart disease, and heart failure treatment.[books.google.com]
  • Echocardiographic case presentation. Case report and literature review. Short case presentation. Paradoxic Decrease in Ischemic Mitral Regurgitation With Papillary Muscle Dysfunction.[rwjms1.umdnj.edu]
  • Mitral regurgitation secondary to ruptured papillary muscle Statistics from Altmetric.com A 68 year old man presented with an acute non-Q wave anterolateral myocardial infarction. He initially made an uneventful recovery.[heart.bmj.com]
Coronary Artery Disease
  • Get comprehensive coverage of all areas of cardiac surgery, including ischemic, valvular, and congenital heart disease; cardiac tumors; constrictive pericarditis; thoracic aortic surgery; cardiac transplantation; coronary artery disease; aortic valve[books.google.com]
  • Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? ‎ Página 1132 - Grines CL, Browne KF, Marco J, et al.[books.google.es]
  • Increasing severity of coronary artery disease and LV dysfunction is associated with worse outcome.[patient.info]
  • A 76 year old female with a history of coronary artery disease and prior inferior wall myocardial infarction presents with gradual onset of increased shortness of breath on exertion and lower extremity swelling.[healio.com]
Congestive Heart Failure
  • Clinically: 64-year-old male patient, acute congestive heart failure with acute mitral-insufficiency caused by papillary muscle rupture. Source: PathoPic[pictures.doccheck.com]
  • In each case severe mitral regurgitation was suggested by the sudden appearance of a systolic murmur followed by progressive congestive heart failure.[nejm.org]
  • Complications congestive heart failure pulmonary hypertension mass-effect from left atrial enlargement (e.g.[radiopaedia.org]
  • Tricuspid regurgitation (A) is another cause of a holosystolic murmur, however does not result from inferior infarction and does not commonly cause congestive heart failure.[healio.com]
Splenectomy
  • A previously healthy 12-year-old girl underwent splenectomy and chest tube insertion for pneumothorax after a traffic accident in a vehicle 15 days before. She was discharged from the hospital after a nine-day follow-up.[ncbi.nlm.nih.gov]
Coarctation of the Aorta
  • […] of the Aorta 581 The Heart in Pregnancy معلومات المراجع[books.google.com]
Collapse
  • It causes rapid hemodynamic collapse, and requires surgical treatment. Recently, cardiac surgeries have increased in the oldest-old patients, however postoperative complications are comparatively high among these patients.[library.dctabudhabi.ae]
Dyspnea
  • An octogenarian male patient was admitted with chest pain and dyspnea, and diagnosed with rupture of the papillary muscle after sub-acute myocardial infarction. Urgent mitral valve replacement was performed.[library.dctabudhabi.ae]
  • After a follow-up of 1 year, he continues to be asymptomatic with respect to dyspnea, and echocardiographic monitoring demonstrates mild-to-moderate mitral regurgitation, which remains stable (Figure 2). Figure 2.[revespcardiol.org]
  • Pulmonary edema will impair normal gas diffusion , and cause dyspnea and -if severe - may lead to death. The consequences of papillary muscle paralysis are quite similar.[hmphysiology.blogspot.com]
  • Pulmonary edema is manifested by shortness of breath, initially with exertion, but later at rest, orthopnea and nocturnal dyspnea attacks.[echopedia.org]
  • A 70-year-old female patient presented with shortness of breath (SOB), progressive dyspnea and chest discomfort for two weeks.[medcraveonline.com]
Respiratory Distress
  • She was presented to our hospital due to respiratory distress. On physical examination, an apical holosystolic murmur radiating to the axillary region was recognized.[ncbi.nlm.nih.gov]
  • He is in marked respiratory distress. Pallor and diaphoresis are noted. His skin is velvety and has multiple scars.[usmleforum.com]
Nausea
  • For the preceding 2 weeks, she had been experiencing intermittent nausea and vomiting; proton pump inhibitors did not improve her symptoms.[circ.ahajournals.org]
Heart Disease
  • This latest revision presents updated clinical information and has eight new chapters, including obesity and metabolic syndrome, women and heart disease, and heart failure treatment.[books.google.com]
  • Diseases 561 Abnormalities of Right Ventricular Outflow 571 Infarction 446 Abnormal Vascular Connections and Structures 600 Suggested Readings 632 INDEX Masses Tumors and Source of Embolus 711 Echocardiography in Systemic Disease and Clinical Problem[books.google.com]
  • Get comprehensive coverage of all areas of cardiac surgery, including ischemic, valvular, and congenital heart disease; cardiac tumors; constrictive pericarditis; thoracic aortic surgery; cardiac transplantation; coronary artery disease; aortic valve[books.google.com]
  • disease or a complication of cardiac dilatation.[fpnotebook.com]
  • Mitral valve stenosis (D) causes a diastolic murmur and is most commonly due to rheumatic heart disease.[healio.com]
Chest Pain
  • An octogenarian male patient was admitted with chest pain and dyspnea, and diagnosed with rupture of the papillary muscle after sub-acute myocardial infarction. Urgent mitral valve replacement was performed.[library.dctabudhabi.ae]
  • An 86-year-old woman with a history of hypertension presented with acute onset of chest pain and evidence of shock (hypotension and tachycardia).[circ.ahajournals.org]
  • Chest pain. Chest pain associated with Mitral Valve Prolapse is different from chest pain associated with coronary artery disease and is a frequent complaint.[hopkinsmedicine.org]
  • Acute mitral regurgitation, particularly due to papillary muscle rupture, or ventricular septal rupture Recurrent ischemic chest pain, with signs of hemodynamic instabilit Contraindications to IABP placement: Significant aortic regurgitation Abdominal[errolozdalga.com]
  • Stenosis Causes of mitral valve stenosis Acquired Degeneracy Rheumatic fever Space occupying lesion Myxoma Congenital Parachute valve Cor triatriatum Effects of mitral valve stenosis: Chest pain, of breath when lying flat, with exertion and attacks during[echopedia.org]
Tachycardia
  • An 86-year-old woman with a history of hypertension presented with acute onset of chest pain and evidence of shock (hypotension and tachycardia).[circ.ahajournals.org]
  • Cardiovascular exam was pertinent for sinus tachycardia without a murmur. Pulmonary exam was notable for bibasilar crackles.[omicsonline.org]
  • Hemodynamics Major goals are relative tachycardia and reduced afterload. Slow heart rates (long diastole and thus regurgitation) and increases in afterload should be avoided.[openanesthesia.org]
  • The initial EKG shows sinus tachycardia with occasional premature ventricular complexes. The chest x-ray reveals no cardiomegaly, but bilateral alveolar infiltrates and hilar prominence are present.[usmleforum.com]
  • People with rhythm disturbances may need to be treated with beta blockers or other medications to control tachycardias (fast heart rhythms).[hopkinsmedicine.org]
Systolic Murmur
  • A systolic murmur was noted and an urgent transoesophageal echocardiogram was performed (top, transgastric view; MV, mitral valve; LV, left ventricle; LA, left atrium).[heart.bmj.com]
  • In each case severe mitral regurgitation was suggested by the sudden appearance of a systolic murmur followed by progressive congestive heart failure.[nejm.org]
  • On auscultation of the heart, an early, decrescendo, systolic murmur at the cardiac apex is heard; the murmur decreases with Valsalva maneuver, and increases with the grip maneuver, radiating to the axilla.[usmleforum.com]
Pansystolic Murmur
  • A typical grade 3/6 pansystolic murmur was heard at the apex with radiation to the axillae.[medcraveonline.com]
  • Auscultation reveals a pansystolic murmur at the apex. Acute MR due to papillary muscle rupture should be considered in patients presenting with acute pulmonary oedema or shock following an acute myocardial infarction.[patient.info]

Workup

  • Diagnostic Workup Diagnostic Workup Figure 1. ECG Figure 2. CXR Day 1 FINDINGS: The lungs are adequately expanded without focal opacity.[hfsa.org]

Treatment

  • Surgical treatment within 48 hours after MI may increase mortality, but expeditious diagnosis and treatment is important to avoid heart failure and LCO.[thieme-connect.com]
  • This latest revision presents updated clinical information and has eight new chapters, including obesity and metabolic syndrome, women and heart disease, and heart failure treatment.[books.google.com]
  • Immediate surgical intervention is considered the optimal and most rational treatment, despite high risks.[ctaegypt.org]
  • It causes rapid hemodynamic collapse, and requires surgical treatment. Recently, cardiac surgeries have increased in the oldest-old patients, however postoperative complications are comparatively high among these patients.[library.dctabudhabi.ae]
  • Surgical treatment of mitral regurgitation due to traumatic rupture of the anterolateral papillary muscle is an uncommon approach.[revespcardiol.org]

Prognosis

  • Prognosis [ 1 ] The best short-term and long-term results are obtained in asymptomatic patients operated on in specialist centres with low operative mortality ( 1%) and high repair rates ( 80-90%). [ 12 ] Acute MR is poorly tolerated and has a poor prognosis[patient.info]
  • Current prognosis of ischemic mitral regurgitation. Implications for future management. Circulation. 1988; 78 (3 Pt 2)-9[ PubMed ] 5. Clements SD, Jr, Story WE, Hurst JW, Craver JM, Jones EL.[zjrms.com]
  • Whenever possible, valve repair is preferred to replacement, as it avoids long-term anticoagulation and, all other things being equal, affords a better long term prognosis.[openanesthesia.org]
  • What is the prognosis for Mitral Valve Prolapse? This condition is usually harmless and does not shorten life expectancy. Healthy lifestyle behaviors and regular exercise are encouraged.[hopkinsmedicine.org]
  • Treatment and prognosis Treatment depends on the whether the mitral regurgitation is acute or chronic.[radiopaedia.org]

Etiology

  • What is the etiology? The most common etiology of acutely elevated right sided pressures is left sided failure. Of course pulmonary embolism is a relatively common cause as well.[hqmeded-ecg.blogspot.com]
  • Mitral regurgitation can be divided into acute and chronic forms, which have differing etiologies and imaging features 1,2.[radiopaedia.org]
  • Etiology is a major determinant of outcome in cardiac surgical patients. Medical and Surgical Treatment Medical treatment may include digoxin, diuretics, and/or vasodilators—including ACE inhibitors.[openanesthesia.org]
  • The most common etiology of LV pseudoaneurysm is AMI. (LV pseudoaneurysm is twice as common with inferior AMI as it is with anterior AMI.) LV pseudoaneurysms may also develop after surgical interventions, especially after mitral valve replacement.[emedicine.medscape.com]
  • Etiology not completely clear but looks like an iatrogenic lesion (good illustration) Myocardial Hemorrhage Following Mitral Valve Replacement: Gross, natural color, horizontal section of left ventricle showing a large area of mural hemorrhage extending[wikidoc.org]

Epidemiology

  • Epidemiology Trivial MR is frequent in healthy subjects.[patient.info]
  • Delling FN, Vasan RS (2014) Epidemiology and pathophysiology of mitral valve prolapse: new insights into disease progression, genetics and molecular basis. Circulation 129(21): 2158-2170.[medcraveonline.com]
Sex distribution
Age distribution

Pathophysiology

  • The severity of complications depends on the larger involvement of the chordae . ( More ruptured chordae causes more severe complications ) To explain the pathophysiological mechanism , lets consider that the ruptured chordae are those of the mitral valve[hmphysiology.blogspot.com]
  • Delling FN, Vasan RS (2014) Epidemiology and pathophysiology of mitral valve prolapse: new insights into disease progression, genetics and molecular basis. Circulation 129(21): 2158-2170.[medcraveonline.com]

Prevention

  • They attach to the cusps of the atrioventricular valves (also known as the mitral and tricuspid valves) via the chordae tendineae and contract to prevent inversion or prolapse of these valves on systole (or ventricular contraction). [1] The papillary[en.wikipedia.org]
  • .: Specific inhibitors and promoters of calcium action in the excitation-contraction coupling of heart muscle and their role in the prevention or production of myocardial lesions. In Calcium and the Heart, ed. ‎[books.google.es]
  • Successful percutaneous coronary intervention with stenting of the RCA was performed ( Figure 1 ); the patient was admitted to the telemetry floor for close monitoring, and continued on intravenous normal saline to prevent contrast-induced nephropathy[elsevier.pt]

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