Abstract
Acute Mitral Regurgitation (MR) after an acute Myocardial Infarction (MI) can be a catastrophic complication of acute MI and requires early recognition and emergent surgical intervention. The classic presentation is that of acute pulmonary edema and cardiogenic shock with recent history of MI. However, we present a case in which a patient presented with acute myocardial infarction and within a few hours, after percutaneous intervention, developed pulmonary edema and shock; reminding readers that this mechanical complication of MI can present at any time and may present with varying severity of symptoms. A high clinical suspicion should be maintained in order to recognize this serious complication and to expedite definitive surgical and life-saving treatment.
Highlights
Acute Mitral Regurgitation (MR) after an acute Myocardial Infarction (MI) can be a catastrophic complication of acute MI and requires early recognition and emergent surgical intervention
He had been experiencing intermittent chest discomfort at rest, 15 hours prior to presentation he experienced acute onset of chest pressure which continued until he presented to the emergency room
The patient was emergently taken to the catheterization suite for coronary angiography which revealed an occlusion of the mid Right Coronary Artery (RCA) as well as a moderate to severe eccentric plaque in the proximal RCA (Figure 2)
Summary
Acute Papillary Muscle Rupture (PMR) is a rare but serious complication of acute myocardial infarction with a mortality rate of 50% within the first 24 hours in those who do not undergo operative intervention [1,2]. PMR, partial or complete, is a rare etiology of MR, occurring in 1% of patients with transmural myocardial infarction [3]. It typically occurs within a few days of an ischemic event [4]. The antero-lateral papillary muscle receives a dual blood supply from the left anterior descending and left circumflex arteries [3]. Both leaflets may be involved serving as a reminder that both the anterior and posterior leaflets have attachments to both papillary muscles [5]. The diagnosis of papillary muscle rupture should be considered at any point in the patient’s course with sudden and unexpected hemodynamic compromise even in the absence of a murmur, Diligent evaluation by TEE, with particular focus on the subvalvular mitral apparatus will provide prompt diagnosis of partial tears in the absence of obvious flail of the mitral leaflets or papillary muscle
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