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Acute inferior myocardial infarction combined with papillary muscle rupture: A case report

Xiexiong Zhao1, Yu Cao2, Jiongxing Wu3

  • 1Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha 410013. 1009314192@qq.com.

Zhong Nan Da Xue Xue Bao. Yi Xue Ban = Journal of Central South University. Medical Sciences
|June 29, 2023
PubMed

Insights

Acute myocardial infarction (AMI) can lead to rare papillary muscle rupture. Early suspicion and intervention are crucial for patients with refractory cardiogenic shock and pulmonary edema.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Critical Care Medicine

Background:

  • The incidence of acute myocardial infarction (AMI) is rising globally.
  • Acute papillary muscle rupture is a rare but severe mechanical complication of AMI, often associated with inferior or posterior myocardial infarction.

Observation:

  • A case of acute inferior myocardial infarction presented with pulmonary edema, refractory cardiogenic shock, and cardiac arrest.
  • The patient underwent emergency percutaneous transluminal coronary angioplasty (PTCA) with intra-aortic balloon pump (IABP) and extra corporeal membrane oxygenation (ECMO) support.
  • Despite revascularization and potential surgical intervention, treatment was withdrawn due to unsuccessful brain resuscitation.

Findings:

  • This case highlights the critical importance of suspecting mechanical complications like papillary muscle rupture in cases of acute inferior myocardial infarction with refractory cardiogenic shock and pulmonary edema.
  • Prompt echocardiography and consideration for surgical intervention are vital when revascularization is feasible.

Implications:

  • Early diagnosis and management of mechanical complications in AMI can improve patient outcomes.
  • Multidisciplinary care involving cardiology, cardiac surgery, and critical care is essential for managing complex AMI cases.
  • The case underscores the challenges in managing severe mechanical complications of AMI, even with advanced life support and revascularization strategies.
Keywords:
acute inferior myocardial infarctioncardiogenic shockmitral regurgitationmitral valve prolapserupture of papillary muscle

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