Isolated papillary muscle rupture with nonobstructive coronary artery disease, minimal myocardial infarction, and normal wall motion

2020 ◽  
Vol 37 (11) ◽  
pp. 1855-1859
Author(s):  
Eleni S. Nakou ◽  
Konstantinos C. Theodoropoulos ◽  
Hizbullah Shaikh ◽  
George Amin‐Youssef ◽  
Mark J. Monaghan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Papillary Muscle ◽  
Wall Motion ◽  
Papillary Muscle Rupture ◽  
Nonobstructive Coronary Artery Disease ◽  
Muscle Rupture ◽  
Normal Wall ◽  
Artery Disease

scholarly journals P1297 Rupture of a Broken Heart: A rare case of acute mitral regurgitation due to papillary muscle rupture complicating Takotsubo cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Chen ◽  
D Abi-Hanna ◽  
J Lambros
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Papillary Muscle ◽  
Obstructive Coronary Artery Disease ◽  
Apical Ballooning ◽  
Papillary Muscle Rupture ◽  
Muscle Rupture ◽  
Artery Disease

Abstract Clinical Case An 89-year old lady presented with symptoms of chest pain and dyspnea, without a significant cardiovascular history, regular medical therapy nor any cardiac risk factors. The electrocardiogram (ECG) demonstrated hyper-acute T waves, and moderate troponin T elevation which peaked at 998 ng/ml. Transthoracic echocardiography (TTE) demonstrated apical ballooning, with hyperdynamic function of the basal left ventricle (LV). These findings were suggestive of a diagnosis of Takotsubo’s cardiomyopathy (TTC), further supported by the coronary angiogram, which confirmed the absence of obstructive coronary artery disease. Notably, her symptoms had not occurred in the setting of emotional or physical stress. The initial recovery was uncomplicated, with no recurrence of symptoms, arrhythmias or cardiac failure. Five days after her presentation, she suddenly experienced severe chest pain and dyspnea associated with profound hypotension. The ECG demonstrated widespread, deep T wave inversion which had evolved over the preceding days, without new ischaemic ST segment changes. Bedside TTE demonstrated severe eccentric mitral regurgitation (MR) with an anteriorly directed jet, not present on earlier TTE, and a hyperdynamic LV. Stability was re-established with intravenous vasopressors, and subsequently with an intra-aortic balloon pump. Transoesophageal echocardiography to evaluate the aetiology of the acute MR demonstrated rupture of the antero-medial papillary muscle with a resultant flail posterior mitral valve leaflet. She was managed with a palliative, non-surgical approach following consideration of her advanced age, frailty, and wishes, and passed away the following day. Discussion TTC is characterized by transient LV impairment, typically due to apical ballooning, with a modest troponin elevation and ECG changes that can mimic acute myocardial infarction. There is, however, an absence of obstructive coronary artery disease. It is most common in post-menopausal females. The overall prognosis is favourable, but can be complicated by cardiac failure, ventricular arrhythmias, and thrombo-embolic phenomena, which carry a significant in-hospital mortality. Rarely, acute MR due to systolic anterior motion of the mitral valve with LV outflow tract obstruction can complicate TTC. Acute MR due to papillary muscle rupture, as in this case, is unusual and has only been reported on a few occasions. The mechanism is not well understood as this pathology is usually found in the context of myocardial infarction, which is excluded on coronary angiography as part of the diagnostic evaluation TTC. Two potential mechanisms have been proposed. As is the case in dilated cardiomyopathy, dilatation of the LV in TTC may create abnormal tension on the tendinae chordae and papillary muscle, or microvascular ischaemia, which has been postulated as a cause for TTC, either of which may then lead to spontaneous papillary muscle rupture. Abstract P1297 Figure.

ANTEROLATERAL PAPILLARY MUSCLE RUPTURE AS A RESULT OF SINGLE-VESSEL CORONARY ARTERY DISEASE WITHOUT MYOCARDIAL INFARCTION

2020 ◽  
Vol 30 (1) ◽  
Author(s):  
Aleksejus Zorinas ◽  
Donatas Austys ◽  
Vilius Janušauskas ◽  
Zita Butkienė ◽  
Rimantas Stukas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Papillary Muscle ◽  
Papillary Muscle Rupture ◽  
Single Vessel ◽  
Vessel Coronary Artery Disease ◽  
Muscle Rupture ◽  
Artery Disease ◽  
Vessel Coronary Artery

The rupture of a papillary muscle is usually associated with the previous occurrence of myocardial infarction, but it may have another etiology. The authors of this article have found no reports about anterolateral papillary muscle rupture caused by a single-vessel coronary artery disease without myocardial infarction. In this paper, an extremely rare case of anterolateral papillary muscle rupture caused by chronic ischemia due to single-vessel coronary artery disease is presented. Since the patient of this case had remained hemodynamically stable and responded well to medical treatment, the mitral valve was successfully repaired 6 weeks after the onset of symptoms.

scholarly journals Mechanisms of Myocardial Infarction in Patients With Nonobstructive Coronary Artery Disease

2019 ◽  
Vol 12 (11) ◽  
pp. 2210-2221 ◽  
Author(s):  
Maksymilian P. Opolski ◽  
Mateusz Spiewak ◽  
Magdalena Marczak ◽  
Artur Debski ◽  
Paul Knaapen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Nonobstructive Coronary Artery Disease ◽  
Artery Disease

scholarly journals Takotsubo Syndrome Associated with ST Elevation Myocardial Infarction

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Saad Ezad ◽  
Michael McGee ◽  
Andrew J. Boyle
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Wall Motion ◽  
Obstructive Coronary Artery Disease ◽  
Takotsubo Syndrome ◽  
St Elevation ◽  
Wall Motion Abnormalities ◽  
Artery Disease

Background. Takotsubo syndrome is a reversible heart failure syndrome which often presents with symptoms and ECG changes that mimic an acute myocardial infarction. Obstructive coronary artery disease has traditionally been seen as exclusion criteria for the diagnosis of takotsubo; however, recent reports have called this into question and suggest that the two conditions may coexist. Case Summary. We describe a case of an 83-year-old male presenting with chest pain consistent with acute myocardial infarction. The ECG demonstrated anterior ST elevation with bedside echocardiography showing apical wall motion abnormalities. Cardiac catheterisation found an occluded OM2 branch of the left circumflex artery with ventriculography confirming apical ballooning consistent with takotsubo and not in the vascular territory supplied by the occluded epicardial vessel. Repeat echocardiogram 6 weeks later confirmed resolution of the apical wall motion abnormalities consistent with a diagnosis of takotsubo. Discussion. This case demonstrates the finding of takotsubo syndrome in a male patient with acute myocardial infarction. Traditionally, this would preclude a diagnosis of takotsubo; however, following previous reports of takotsubo in association with coronary artery dissection and acute myocardial infarction in female patients, new diagnostic criteria have been proposed which allow the diagnosis of takotsubo in the presence of obstructive coronary artery disease. This case adds to the growing body of literature that suggests takotsubo can coexist with acute myocardial infarction; however, it remains to be elucidated if it is a consequence or cause of myocardial infarction.

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