Rupture of papillary muscle during dobutamine stress echocardiography

Area of Science:

• Cardiology
• Cardiac Surgery
• Diagnostic Imaging

Background:

• Acute myocardial infarction (MI) management varies based on ST-elevation status.
• Non-ST elevation MI (NSTEMI) often receives conservative treatment initially.
• Stress testing is utilized to assess myocardial viability and function post-MI.

Observation:

• A 72-year-old male presented with NSTEMI and did not receive reperfusion therapy.
• Dobutamine stress echocardiography was performed five days post-MI.
• The patient experienced a partial posterior papillary muscle rupture during the stress test, leading to cardiogenic shock.

Findings:

• Partial papillary muscle rupture is a rare but serious complication of myocardial infarction.
• Stress-induced papillary muscle rupture can precipitate acute, severe mitral regurgitation and cardiogenic shock.
• Early medical management and surgical intervention (mitral repair) can be effective in treating this complication.

Implications:

• This case highlights the importance of careful monitoring and diagnostic evaluation, even in NSTEMI patients.
• Stress echocardiography, while diagnostic, can unmask latent complications like papillary muscle rupture.
• Timely surgical mitral valve repair is crucial for hemodynamic stabilization and improved outcomes in patients with post-MI papillary muscle rupture and cardiogenic shock.