Clinical and pathologic factors contributing to acute papillary muscle ischemia

Hearts from 110 consecutive adult autopsies were examined to determine the frequency and predisposing clinical and pathologic features of acute left ventricular papillary muscle ischemia. Acute infarcts of papillary muscles were present in 23% of the hearts and were more frequent than acute infarcts of their corresponding ventricular walls. Patients with acutely infarcted papillary muscles were more likely to have significant stenosis of the corresponding coronary artery than were patients with normal papillary muscles. Increasing heart weight was also associated with increased frequency of papillary muscle acute infarction. Patients with acutely infarcted papillary muscles were more likely to have had hypertension and to have suffered significant hypotension prior to death than were patients with normal papillary muscles.