Ischaemic papillary muscle rupture without significant coronary artery lesion

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Imaging

Background:

• Papillary muscle rupture is a rare but severe complication following myocardial infarction (MI).
• It often leads to acute, life-threatening mitral regurgitation and hemodynamic instability.
• Prompt diagnosis and surgical intervention are critical for patient survival.

Observation:

• A 76-year-old female presented with cardiac arrest upon admission.
• Severe mitral regurgitation was identified, despite the absence of significant coronary artery disease.
• Emergency surgery revealed a ruptured posteromedial papillary muscle.

Findings:

• Cardiac magnetic resonance imaging post-surgery confirmed a microscopic myocardial infarction (MI) specifically affecting the posteromedial papillary muscle.
• This finding established the etiology of the papillary muscle rupture.

Implications:

• This case underscores that even microscopic myocardial infarctions can precipitate catastrophic events like papillary muscle rupture.
• It highlights the importance of considering papillary muscle rupture in patients with acute mitral regurgitation and cardiac arrest, even with non-obstructive coronary arteries.
• Advanced imaging modalities are crucial for diagnosing the underlying cause of such complications.