title: Acute severe mitral regurgitation with cardiogenic shock caused by two-step complete anterior papillary muscle rupture during acute myocardial infarction.
abstract: BACKGROUND
  Rupture of a papillary muscle is an infrequent but often fatal mechanical complication of acute myocardial infarction.
  
  
  OBJECTIVE
  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.
authors.affiliation: 1st Department of Internal Medicine, University Hospital, Olomouc, Czech Republic. martinhutyra@seznam.cz
authors.forename: Martin
authors.initials: M
authors.lastname: Hutyra
authors.forename: Tomas
authors.initials: T
authors.lastname: Skala
authors.forename: Dan
authors.initials: D
authors.lastname: Marek
authors.forename: Petr
authors.initials: P
authors.lastname: Nemec
authors.forename: Martin
authors.initials: M
authors.lastname: Sluka
authors.forename: Jiri
authors.initials: J
authors.lastname: Ostransky
authors.forename: Marek
authors.initials: M
authors.lastname: Richter
authors.forename: Jan
authors.initials: J
authors.lastname: Lukl
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000150:complications*; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology*; D010210:Papillary Muscles; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology*