Papillary muscle insufficiency and rupture in the elderly

Introduction to nipple dysfunction and fracture in the elderly Papillary muscle dysfunction refers to the clinical syndrome of mitral regurgitation caused by papillary muscle lesions causing their systolic dysfunction or changes in the position of the papillary muscles and unable to maintain the normal closure of the mitral valve. Clinically referred to as papillary muscle dysfunction refers to left ventricular papillary muscle lesions. Because the papillary muscle contraction pulls the valve to do the most work, but because it is in the innermost layer of the ventricle, the blood supply comes from the terminal part of the coronary artery. When the coronary blood supply is reduced, the papillary muscle ischemia and necrosis are most likely to occur. basic knowledge The proportion of illness: 0.005% Susceptible people: the elderly Mode of infection: non-infectious Complications: acute left heart failure in the elderly, cardiogenic shock

Elderly papillary muscle dysfunction and fracture etiology

(1) Causes of the disease

1. papillary muscle ischemia, infarction and fibrosis

The most common cause of senile papillary dysfunction is coronary heart disease and aortic stenosis. The former is caused by coronary atherosclerosis caused by stenosis, which reduces blood supply. The latter is caused by a decrease in cardiac output due to aortic stenosis and reduced coronary blood flow. When angina pectoris occurs, the papillary muscle ischemia can not maintain its own tension to resist the pressure generated by left ventricular contraction, causing transient mitral regurgitation, intermittent episodes due to improved papillary muscle supply, mitral valve Close normal, acute myocardial infarction, due to nipple muscle necrosis can occur mitral regurgitation, mostly permanent, but also temporary (recovery period disappears), long-term chronic ischemia of the papillary muscle can cause fibrosis, shortening of the papillary muscles , hindering the normal closure of the mitral valve, leading to mitral regurgitation.

2. The papillary muscle is normal and the relationship between the papillary muscle and the mitral valve is abnormal.

Under normal circumstances, when the left ventricle contracts, the two groups of papillary muscles are close to each other until their long axis is at an angle of 90° to the plane of the mitral valve orifice. The tension generated by the papillary muscle is perpendicular to the plane of the mitral valve orifice, and the left ventricle is enlarged. When the papillary muscles are displaced to the sides, the long axis of the papillary muscles is no longer parallel to the long axis of the ventricular cavity and is in a horizontal position. When the papillary muscles contract, the mitral valve leaflets cannot be engaged but the valve leaflets are opened, resulting in a mitral valve. Reflux, papillary muscle contraction can cause the mitral valve leaf to be pulled away from closure when the papillary muscle basal ventricular dyskinesia (myocardial fibrosis), the opposite movement (ventricular aneurysm), and hypertrophic cardiomyopathy shift the papillary muscles The position that leads to mitral regurgitation.

The main cause of nipple muscle rupture in the elderly is acute myocardial infarction. The chordae rupture in the elderly is common in mitral mucoid degeneration and infective endocarditis.

(two) pathogenesis

The disease is due to the posterior papillary muscle close to the ventricular septum, only the posterior descending branch and the left circumflex artery supply blood, far from the left and right coronary artery opening, so the blood transport is worse than the anterior papillary muscle, plus the valve degeneration or myocardial infarction, Therefore, papillary muscle dysfunction and rupture occur.

Elderly papillary muscle dysfunction and fracture prevention

Preventive measures include the following:

1 Actively adopt various methods such as thrombolysis, emergency coronary angioplasty, bypass grafting, etc., so that the occluded coronary artery can be recanalized as soon as possible to save the sudden death of the myocardium and effectively limit or reduce the infarct size.

2 to maintain blood pressure stability, AMI such as hypotension and shock, we must strictly control the concentration of blood pressure drugs and the rate of drop, so that blood pressure rises to a suitable level, avoid sudden and large fluctuations in blood pressure, if there is high blood pressure need to use When compressing the drug, it is possible to use a intravenous antihypertensive drug which has a quick onset effect and a fast disappearing action, and avoids the use of an antihypertensive drug which is slow in oral administration and has a long effect.

3 Keep the stool smooth, avoid exerting stools, and stay in bed in the acute phase to avoid fatigue or body and activity.

4 rational application of anticoagulant therapy: in the absence of conditions for thrombolysis or emergency coronary endoscopic surgery, if there is no contraindications to anticoagulation therapy, heparin can be given early to prevent infarction, but should prevent overdose, If there is a pericardial friction sound, the anticoagulant should be stopped in time.

Elderly papillary muscle dysfunction and fracture complications Complications, elderly patients with acute left heart failure, cardiogenic shock

Accompanied by acute left heart failure and cardiogenic shock.

Papillary muscle dysfunction and rupture symptoms in the elderly Common symptoms Fatigue papillary muscle rupture edema Qi angina pectoris palpitations diastolic galloping hospitable murmur myocardial infarction ventricular septal defect

The clinical manifestation depends on the onset of urgency, mitral regurgitation and primary disease, gradual mild papillary muscle dysfunction, due to small hemodynamic effects, can be asymptomatic, severe palpitations, shortness of breath, cough , fatigue and other left heart failure manifestations, papillary muscle rupture occurs acute mitral valve regurgitation, leading to acute pulmonary edema and cardiogenic shock, papillary muscle rupture occurs more than 5 to 7 days after acute myocardial infarction, a few within 3 weeks The posterior medial papillary muscle rupture is common in acute penetrating inferior myocardial infarction, and the anterior lateral papillary muscle rupture is the consequence of acute anterior wall myocardial infarction.

The main sign is the systolic murmur of the anterior region (levels II to IV). The location of the murmur and the direction of the conduction depend on the affected papillary muscle. When the posterior medial papillary muscle is involved, the reflux blood ventricular septum and the aortic root, and the murmur is close to the sternum. The most loud, conduction to the bottom of the heart, can be misdiagnosed as aortic valve stenosis or ventricular septal defect; when the anterior lateral papillary muscle is involved, the reflux blood impacts the posterior wall of the left atrium, the murmur is transmitted to the left axillary, and the murmur is variability. The murmur is most loud before contraction, and weakens after contraction; angina pectoris is louder and lessened after remission; in different cardiac cycles, early, middle, late or full systolic murmurs can be presented; inhalation or snoring noise Enhancement, and vice versa, due to the complete rupture of the papillary muscle, the mitral valve almost loses its activity, the left atrioventricular is the same large heart chamber, no blood vortex, and thus no noise, followed by the first heart sound enhancement and diastolic Malu (85%), due to dysfunction of the papillary muscles, the chordae are in a relaxed state in the early stage of contraction, and the ventricle continues to contract, causing the pressure to rise suddenly, forcing the closed mitral valve to protrude in the left atrium and suddenly tightening. Relaxation chordae generating a first heart sound enhancement, addition, the disease may be associated with popping sound, or even only sound without popping noise.

For elderly patients with coronary heart disease, such as the newly appearing systolic murmur in the anterior region, the first heart sound enhancement and diastolic galloping, these three characteristics should be highly suggestive, hemodynamic examination found pulmonary artery wedge There is a huge V wave on the pressure curve to determine the diagnosis of the disease. Left ventricular angiography can help to determine the degree of mitral regurgitation. Ultrasound is helpful to distinguish between papillary muscle dysfunction or papillary muscle necrosis.

Elderly papillary muscle dysfunction and fracture examination

Blood tests, such as white blood cells during myocardial infarction, can be elevated.

1. Hemodynamic examination, found that the pulmonary artery wedge pressure, the curve has a huge V wave.

2. Ultrasound examination can distinguish between papillary muscle dysfunction or papillary muscle necrosis.

Diagnosis and diagnosis of nipple dysfunction and fracture in the elderly

Diagnosis of this disease also needs to be distinguished from ventricular septal perforation, mitral annular calcification and mitral mucoid degeneration.

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