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

Q3 Medicine
Case Reports in Critical Care Pub Date : 2021-12-21 eCollection Date: 2021-01-01 DOI:10.1155/2021/1396194
Akiko Kameyama, Hiroshi Imamura, Hiroshi Kamijo, Kanako Takeshige, Katsunori Mochizuki, Kenichi Nitta
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引用次数: 1

Abstract

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.

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急性心肌梗死后乳头肌破裂相关急性二尖瓣反流的诊断缺陷。
乳头状肌破裂是急性心肌梗死(AMI)的一种罕见且致命的并发症。我们报告一例急性二尖瓣反流(MR)由于PMR肺水肿和心源性休克后AMI小心肌坏死。一位88岁的妇女因急性呼吸窘迫、休克和昏迷被送到急诊科。她没有收缩期杂音,经胸超声心动图无结论。冠状动脉造影显示右冠状动脉后降支梗阻。梗死虽小,但血流动力学未见改善。入院后5天经食管超声心动图证实乳头肌破裂伴严重二尖瓣反流。此后,患者及其家属不同意进行心脏手术,最终死于进行性心力衰竭。对于血流动力学不稳定、无收缩期杂音、经胸超声心动图未发现异常的AMI患者,医生应注意乳头肌破裂合并急性二尖瓣反流。
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来源期刊
Case Reports in Critical Care
Case Reports in Critical Care Medicine-Critical Care and Intensive Care Medicine
CiteScore
2.10
自引率
0.00%
发文量
26
审稿时长
12 weeks
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