Anterolateral papillary muscle rupture caused by myocardial infarction: A case report

Jayawardena, Suriya; Renteria, Anne S.; Burzyantseva, Olga; Lokesh, Gowda; Thelusmond, Louis

doi:10.1186/1757-1626-1-172

Cited by 6 publications

(4 citation statements)

References 12 publications

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“…It is well-known that the left anterior descending artery (LAD) through its branches provides blood supply for a major part of the left ventricular myocardium, as well as the anterior and mid thirds of the IVS 9 . Its first diagonal branch provides blood for ALPM 10 , while anterior part of the IVS obtains blood from the septal branches of the LAD 9 . Having in mind anatomic location of the mentioned blood vessels, in addition to the location of the lipoma, there is a strong possibility that the compression of these arteries caused by the tumor mass lead to the ischemia of the IVS and ALPM.…”

Section: Discussionmentioning

confidence: 99%

Giant intrapericardial lipoma: Clinical and forensic implications

et al. 2023

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Introduction. Even though lipomas are the most common benign tumors, they are rarely found in the pericardial cavity. Although histopathological benign, they can cause lifethreatening complications by rapid growth and, therefore, clinically may be considered as malignant. Case report. We present a case of an 80-year-old female who was injured during syncopial episode, when falling from standing height and later died in the hospital without an obvious cause of death. At the autopsy, a dilated and tense pericardium filling up a large part of the chest cavity was noted. A well-encapsulated soft tissue mass, 20x18x3cm in size and measuring 820 g, was visualized in the pericardial cavity. Histopathological examination revealed that the mass was lipoma and showed acute myocardial necrosis and, therefore, it was assumed that the cause of death was myocardial infarction, probably due to the compression of lipoma on coronary arteries. Conclusion. Even though intrapericardial lipomas are benign tumors, they can cause life-threatening complications and sudden cardiac death. There are numerous diagnostic methods capable of detecting intrapericardial lipomas, and with timely treatment patient can be cured.

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Section: Discussionmentioning

confidence: 99%

Giant intrapericardial lipoma: Clinical and forensic implications

et al. 2023

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“…1,2 In people who experience coronary arterial occlusion, the posterior PM is subject to higher incidences of hypoxic damage, likely related to the differential coronary perfusion to this muscle. [5][6][7][8] Differential perfusion pressure between the PMs may be in part responsible for the coronary vascular findings presented in this study in dogs, and therefore differential responses to injury may also occur.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 This disparity contributes to a higher incidence of posterior PM rupture in the context of myocardial infarction in people. 4,7,8 This rupture can lead to mitral valve regurgitation, which is a clinically important prognostic indicator. 3,9 Furthermore, the PMs are the last portion of the heart to be perfused, and thus show evidence of inadequate myocardial oxygenation, are more sensitive to hypoxia, and are more prone to ischemic injury.…”

Section: Introductionmentioning

confidence: 99%

Characterization of Spontaneous Vascular Findings in the Papillary Muscles of Beagle Dogs

Kohnken

Weber

2020

Toxicol Pathol

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Standard histology trimming practices for toxicity studies in dogs include preparation of a section of the papillary muscle associated with the left ventricular free wall—the anteriolateral or anterior muscle. In contrast, the posteromedial or posterior papillary muscle, associated with the interventricular septum, is not commonly evaluated. In humans, the posterior papillary muscle is more often affected in ischemic myocardial disease, in large part due to the absence of collateral circulation, in contrast to the anterior muscle. Due to the differential vascular supply to the papillary muscles, we sought to determine whether there is a higher incidence of spontaneous coronary vascular changes in the posterior papillary muscle versus the anterior muscle in dogs. The hearts of 30 vehicle-treated or untreated beagle dogs that were euthanized for other purposes were collected and sectioned in a consistent manner to include both papillary muscles for histologic evaluation. The posterior muscle consistently had higher incidences of intramural coronary arteries affected by vascular medial hypertrophy, medial arteriosclerosis, intimal hyperplasia, and/or disruption or loss of the internal elastic lamina. This observation may have significant implications for the evaluation and characterization of spontaneous and xenobiotic-induced cardiovascular lesions in dogs.

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“…It occurs in about 1% of patients mostly on the 2nd to 7th day of infarction, usually on the inferior wall, among elderly women with single-vessel coronary disease suffering from diabetes. Preponderantly the posteromedial papillary muscle becomes damaged (6-12 times more often); unlike the anterolateral one, it is vascularised only in one coronary artery (a branch of the posterior descending right coronary artery in 95% of cases, or more rarely the third marginal artery branching off from the circumflex artery) [4,5,8] . The basic treatment in acute mitral regurgitation caused by ischemic papillary muscle rupture is surgery.…”

Section: Discussionmentioning

confidence: 99%

The Rupture of the head of postmedial papillary muscle. Mechanical complications of myocardial infraction with normal angiographic image of coronary vessels.

Przybylski¹,

Kurianowicz²,

Kądziela³

et al. 2017

Heart Beat

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Key words:myocardial infarction, MINOCA, the rapture of the head of postmedial papillary muscle, mechanical complications of myocardial infarction, acute mitral regurge. AbstractMyocardial infarction with non-obstructive coronary arteries (MINOCA) is usually mild in course without any life-threatening complications.This paper presents an atypical case of a 74-year-old patient with myocardial infarction who despite a normal angiography image suffered from complete tear of the head of the posteromedial papillary muscle followed by acute cardiac failure and cardiogenic shock. Case studyA 74-year-old female patient was treated for arterial hypertension, adult-onset diabetes, and paroxysmal atrial fibrillation. After implanting a dual-chamber cardiac pacemaker, as a result of second degree atrioventricular block, she was admitted to the Cardiology Ward with expanded pulmonary edema and low arterial blood pressure. Five days earlier the patient had reported coronary pain in the chest.Following admission the patient's condition was generally severe with dyspnea at rest, which required passive oxygen therapy, but without chest pain.Physical examination showed: arterial blood pressure of 90/60 mm/Hg (in spite of using pressor amines), normal heart rate (60/min), auscultatory loud systolic murmur above the heart apex radiating to the left axillary fossa and scapula, features characteristic for pulmonary congestion (class IV according to Killip and Kimball), blood oxygen saturation 79%, mild swelling of lower legs, normal body temperature. Laboratory investigation indicated highly elevated levels of troponin T, N-terminal-pro B type natriuretic peptide (NT-proBNP) and C reactive protein (CRP). Then, the electrocardiogram showed atrial fibrillation, and left bundle branch block with periodic and effective ventricular pacing. The indicative bedside transthoracic echocardiogram (TTE) presented lowered systolic function of the left ventricle muscle (EF about 40%) with hypokinesis of the inferolateral, inferior, and lateral walls, as well as presence of hemodynamically significant mitral regurgitation due to prolapse of the posterior valve leaflet. As a matter of urgency, the diagnostics were extended to transe-

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Anterolateral papillary muscle rupture caused by myocardial infarction: A case report

Abstract: Background: The rupture of the anterolateral papillary muscle is less common than the posteromedial papillary muscle since the anterolateral muscle has dual blood supplies, while the posteromedial papillary muscle has a single blood supply.

Cited by 6 publications

References 12 publications

Giant intrapericardial lipoma: Clinical and forensic implications

Giant intrapericardial lipoma: Clinical and forensic implications

Characterization of Spontaneous Vascular Findings in the Papillary Muscles of Beagle Dogs

The Rupture of the head of postmedial papillary muscle. Mechanical complications of myocardial infraction with normal angiographic image of coronary vessels.

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