Papillary muscle rupture

Introduction Papillary muscle rupture is a less common complication of heart rupture. According to the autopsy pathological report of 107 cases of myocardial infarction in Beijing Fuwai Cardiovascular Hospital, the anterior papillary muscle and posterior papillary muscle rupture accounted for 1.9%, which was consistent with 1% in the literature. This is mainly because the blood supply to the papillary muscle is poor, often there is chronic ischemia or small infarction, and there are more fibrous scars, so it is not easy to completely break. Most occur within a week after acute myocardial infarction.

Cause

Papillary muscle fracture mainly involves the posterior papillary muscle, which occurs 6 to 12 times of the anterior papillary muscle rupture, so the posterior papillary muscle rupture is more common than the anterior papillary muscle rupture, which may be related to the difference in blood supply. The anterior papillary muscle blood usually comes from the left anterior branch of the left anterior descending or the left circumflex branch, with a double blood supply, and more collateral anastomosis between the arteries, and the blood source of the posterior papillary muscle. The variation is larger. The blood may come from the posterior descending branch of the right coronary artery or (and) the left circumflex, often a single vessel supply, so the left ventricular posterior papillary muscle is more susceptible to ischemia than the anterior papillary muscle. Posterior papillary muscle rupture is common in acute inferior myocardial infarction, and left anterior papillary muscle rupture is often the result of acute anterior myocardial infarction. Right ventricular papillary muscle rupture is extremely rare. Papillary muscle fracture can be divided into two types: complete fracture and partial fracture. According to the literature, the anterior papillary muscle rupture is the entire fracture, probably because the anterior papillary muscle is still a solid body, and the posterior papillary muscle rupture is mostly partial fracture, probably because the posterior papillary muscle is composed of multiple nipples. Therefore. Complete rupture leads to massive regurgitation of the acute mitral valve, causing severe acute pulmonary edema. About one-third of the patients die immediately, and half of the patients die within 24 hours. Partial rupture can lead to severe mitral regurgitation, with survival for several days, with significant heart failure.

an examination

Related inspection

ECG chest CT examination

In patients with acute myocardial infarction, new systolic murmurs appear in the apex of the heart, and acute acute left heart failure and/or shock appear immediately in the clinic. Hemodynamic monitoring shows a huge V wave in the pulmonary capillary wedge pressure curve without left to right. Divided signs, X-ray chest radiograph showed signs of severe pulmonary edema, Doppler ultrasound or left ventricular angiography showed mitral regurgitation, can be diagnosed.

Differential diagnosis

Differential diagnosis of papillary muscle rupture:

Identification of papillary muscle dysfunction and papillary muscle rupture:

1, the frequency of occurrence: the former is common, the latter is rare.

2, the appearance time: the former often unconsciously occurred, in any time angina or myocardial infarction, the latter suddenly occurred within 1 week after acute myocardial infarction.

3, the characteristics of systolic murmur: the former 1 occurs after the first heart sound, the noise is often confined to the apical region. 2 transient is positively correlated with the degree of myocardial ischemia. 3 After the premature beat can be alleviated; the latter coincides with the first heart sound, the murmur is extensive in the apical region, and remains unchanged after the premature beat.

4, the first heart sound: the former 70% first heart sounds bright, the latter soft.

5, nipple muscle involvement: the former before and after the nipple muscle involvement, the latter after the internal papillary muscle involvement is 2 times the anterior papillary muscle.

6, the course of disease: the former does not occur pulmonary edema, the condition is stable, the latter suddenly pulmonary edema, the condition turned sharply.

7, surgery: the former often does not require surgery, the latter advocates surgical treatment.

In patients with acute myocardial infarction, new systolic murmurs appear in the apex of the heart, and acute acute left heart failure and/or shock appear immediately in the clinic. Hemodynamic monitoring shows a huge V wave in the pulmonary capillary wedge pressure curve without left to right. Divided signs, X-ray chest radiograph showed signs of severe pulmonary edema, Doppler ultrasound or left ventricular angiography showed mitral regurgitation, can be diagnosed.

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