Acute severe mitral regurgitation with cardiogenic shock caused by two-step complete anterior papillary muscle rupture during acute myocardial infarction.
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.
Hutyra
Martin
M
1st Department of Internal Medicine, University Hospital, Olomouc, Czech Republic. martinhutyra@seznam.cz
Skala
Tomas
T
Marek
Dan
D
Nemec
Petr
P
Sluka
Martin
M
Ostransky
Jiri
J
Richter
Marek
M
Lukl
Jan
J
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*