Accepted
at 5:06 p.m. Oct, 31, 2023
by
Joe
Author:
mil2med
Type of change:
Content error
Rationale for change
FA and Additional Resources state papillary muscle rupture occurs between 2-7 days.
Retraction: UWORLD 25825 -> 3-5 days. Added table to additional resources.
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- Presents with sudden-onset pulmonary edema, hypotension, and a systolic murmur (cardiac apex)
- Ischemia → papillary muscle rupture → mitral regurgitation leading to pulmonary edema
- Due to macrophage-mediated structural degradation
- Presents with sudden-onset pulmonary edema, hypotension, and a systolic murmur (cardiac apex)
- Ischemia → papillary muscle rupture → mitral regurgitation leading to pulmonary edema
*Posteromedial papillary muscle is supplied by the PDA (assuming right-dominant look for RCA infarct, ST elevations from leads II, III, and aVF can be seen)
Photo credit: Zorkun, CC BY-SA 3.0, via Wikidocs
| Timeline | Complication | Extra |
|---|---|---|
| Days to months | Arrhythmia | Common cause of death post-MI |
| 1-3 days | Fibrinous pericarditis | Friction rub |
| < 1 week | Papillary muscle rupture | Posteromedial, mitral regurgitation |
| Interventricular wall rupture | VSD, ↑O2 sat in the RV | |
| < 2 weeks | Ventricular pseudoaneurysm | Contained within the pericardium |
| Ventricular free wall rupture | Cardiac tamponade | |
| 2 weeks - months | True ventricular aneurysm | Contains all 3 layers |
| Dressler syndrome | Autoimmune mediated fibrinous pericarditis |
Lecture Notes
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Missed Questions
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Pathoma
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Boards and Beyond
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First Aid
Sketchy
Sketchy 2
Sketchy Extra
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Picmonic
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Pixorize
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Physeo
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Bootcamp
OME
Additional Resources
Papillary muscle rupture
Photograph of a heart at autopsy (close-up of the left ventricle in longitudinal section)
The posteromedial papillary muscle of the mitral valve has ruptured and almost completely detached from its ventricular attachment.
This is the characteristic appearance of papillary muscle rupture, a complication of myocardial infarction. The posteromedial papillary muscle is supplied by the posterior descending artery and is susceptible to ischemia and rupture in individuals with critical occlusion of this artery.
Ruptured papillary muscle
Photograph of a heart at autopsy (close-up of the left ventricle in longitudinal section)
The anterolateral papillary muscle of the mitral valve has avulsed from its ventricular attachment. The posteromedial papillary muscle is mostly intact, except for a small area of ischemic necrosis near its attachment to the chordae tendineae. The chordae tendineae are the white strings connecting the papillary muscles to the mitral valve.
This is the characteristic appearance of papillary muscle rupture, a complication of myocardial infarction.
→ acute onset of pulmonary edema, hypotension, dyspnea/tachypnea, and soft systolic murmur (MR)
One by one
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