Severe papillary muscle dysfunction substantiated by atrial pacing during cardiac catheterization

Area of Science:

• Cardiology
• Cardiovascular Physiology

Background:

• Nocturnal angina pectoris and episodic pulmonary edema can indicate underlying cardiac dysfunction.
• Atrial pacing during cardiac catheterization can unmask latent cardiac conditions.

Observation:

• A patient presented with symptoms of pulmonary edema and angina during atrial pacing.
• Hemodynamic monitoring revealed a large V wave in the pulmonary artery wedge pressure, indicative of acute mitral valve regurgitation.

Findings:

• The observed symptoms and hemodynamic changes were acutely provoked by atrial pacing.
• Nitroglycerin administration rapidly reversed the pulmonary edema and mitral regurgitation, suggesting transient papillary muscle dysfunction.

Implications:

• Papillary muscle dysfunction can be a cause of acute mitral valve regurgitation and associated symptoms.
• This case highlights the importance of considering papillary muscle dysfunction in patients with episodic cardiac events.