Rejected at 3:28 a.m. Nov, 01, 2023 ] by Cameron
Author: Roby_VI
Related Note: 1471899395392
Rationale for change

Posteromedial muscle rupture is almost always the only papillary muscle of concern as one would need to disrupt the dual blood supply of the anterolateral papillary muscle for it to rupture.
https://www.ncbi.nlm.nih.gov/books/NBK499976/

Also, papillary muscle always causes at least some degree of MR, so I removed the word often because it is unnecessarily cautious. Whether the MR is significant is another matter. I would support saying "often causes significant mitral regurgitation" as an alternative.

Also, in the extra notes it says the "papillary muscle" is supplied by the RCA. This simply isn't true, firstly, there are two papillary muscles, and of those, one (the posteromedial) may be supplied by the RCA if circulation is right dominant. The anterolateral has dual blood supply from the LAD and LCx.
https://www.ncbi.nlm.nih.gov/books/NBK537357/

Rejection reason

Thank you for the input, but please submit your suggestions with an **acceptable source**. Acceptable sources include specific UWorld QIDs + explanation, specific AMBOSS article links with text for rationale, specific FA 2023 page numbers, and other cards in the deck (list specific nid #). Unacceptable sources include FA 2022 or older, Pathoma, B&B, Sketchy, random articles, and wikipedia.

UpToDate is not an acceptable standalone source, and requires verification from AMBOSS or UWorld. Our goal is to help learners test better and score better, and we will often defer to board resources over clinical practice guidelines when there is a discrepancy.

Text Text
Extra Extra
Lecture Notes
Empty field
Missed Questions
Empty field
Pathoma
Empty field
Boards and Beyond
Empty field
First Aid


Sketchy Extra
Empty field
Picmonic
Empty field
Pixorize
Empty field
Physeo
Empty field
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
Empty field
#AK_Step2_v12::#AMBOSS::Pu0Wr3 #AK_Original_Decks::Step_2::Cheesy_Dorian_(M3) #AK_Step1_v12::^Other::^HighYield::2-RelativelyHighYield #AK_Step2_v12::#Resources_by_rotation::IM::uw::cardio::cardio_zanki !AK_UpdateTags::Table::Post_Myocardial_Infarction_Timeline #AK_Original_Decks::Step_1::Zanki_Step_Decks::Zanki_Cardiovascular::Cardio_Pathology #AK_Step1_v12::#Pathoma::08_Cardiac::01_Ischemic_Heart_Disease !AK_UpdateTags::step2PotentialDupes::Forrest::Combine_haveValue #AK_Step1_v12::#FirstAid::07_Cardiovascular::04_Pathology::16_Evolution_of_myocardial_infarction::*4-7_Days #AK_Step2_v12::#NBME #AK_Step2_v12::#SketchyIM::01_Cardiology::08_Valvular_Disease::03_Mitral_Regurgitation_&_Mitral_Valve_Prolapse_SOAP #AK_Step1_v12::#SketchyPath::01_Cardiac::01_Ischemic_Heart_Disease::03_Acute_Myocardial_Infarction_&_Post-MI_Timeline #AK_Step2_v12::Original_decks::Zanki_Step_2::IM::Cardio #AK_Step2_v12::#SketchyIM::01_Cardiology::01_Ischemic_Heart_Disease::08_MI_Complication_SOAP #AK_Step1_v12::#UWorld::Step::14978 #AK_Step2_v12::#Subjects::Cardiology::02_Coronary_Artery_Disease::MI::Complications::Papillary_Muscle_Rupture #AK_Step1_v12::#AMBOSS #AK_Step1_v12::#SketchyPath::01_Cardiac::04_Valvular_Disorders::02_Mitral_Valve_Regurgitation_&_Prolapse #AK_Step1_v12::#Physeo::11_Pathology::01_Cardiac_Pathology::06_Myocardial_Infarction #AK_Step2_v12::#B&B::02_Cardio::02_Ischemic_Heart_Disease::02_STEMI::Extra #AK_Step2_v12::#Subjects::Cardiology::02_Coronary_Artery_Disease::MI #AK_Step2_v12::#UWorld::COMLEX::27976 !AK_UpdateTags::AnKing_Image::Mujeeb::Evolution_of_myocardial_infarction #AK_Step1_v12::#NBME::16 #AK_Step2_v12::#Resources_by_rotation::Surgery::amboss::dorian::cardio&vascular #AK_Step2_v12::!Shelf::Surgery #AK_Step1_v12::#Bootcamp::Cardiology::20_Valvular_Disease::05_Mitral_Regurgitation !AK_UpdateTags::Step1decks::Zanki-Step-Decks::Zanki-Cardiovascular::Cardio-Pathology #PANCE::EOR::IM #AK_Step1_v12::#UWorld::COMLEX::26051 #AK_Step2_v12::#SketchyIM::01_Cardiology::12_Retired_Lessons::01_Ischemic_Heart_Disease::04_MI_Complications_SOAP_[OLD_VERSION] #AK_Step1_v12::#AMBOSS::zjar1k #AK_Step2_v12::Original_decks::Dorian::surg::amboss::cardio&vascular #PANCE::EOR::Family_med #AK_Step1_v12::#B&B::05_Cardio::01_Anatomy_and_Physiology::01_Cardiac_Anatomy::Extra #AK_Step1_v12::#AMBOSS::bcaHaj #AK_Step1_v12::#B&B::05_Cardio::02_Cardiac_Ischemia::03_Cardiac_Ischemia_II #AK_Step2_v12::Original_decks::Dorian::im::uw::cardio #AK_Step2_v12::#OME::01_Medicine::01_Cardiology::02_Acute_Coronary_Syndrome #AK_Step2_v12::#UWorld::Step::2157 #AK_Step1_v12::#AMBOSS::dPaodk !AK_UpdateTags::AnKing_Image::!Subjects::Cardiology::Evolution_of_myocardial_infarction #AK_Step1_v12::#Bootcamp::Cardiology::24_Myocardial_Infarction::03_Post-Myocardial_Infarction_Timeline #AK_Step1_v12::#OME::PreClinical::Cardiac #AK_Step1_v12::#SketchyAnatomy::02_Thorax::02_Heart::03_Coronary_Circulation_Clinical_Correlates #AK_Step2_v12::#NBME::Form11 #AK_Step2_v12::!Shelf::IM::no_dupes #AK_Step2_v12::#SketchyIM::01_Cardiology::12_Retired_Lessons::01_Ischemic_Heart_Disease::03_Acute_Coronary_Syndromes_SOA_[OLD_VERSION] #AK_Step2_v12::#OME::06_Surgery::03_Surgical_Subspecialties::06_CT_Surgery #AK_Step2_v12::#Resources_by_rotation::IM::uw::cardio::cardio_dorian #PANCE::CARDIO::coronary_artery_disease !AK_UpdateTags::Step2decks::Cheesy-Dorian-(M3)::Surgery::6-AMBOSS #AK_Step2_v12::#SketchyIM::01_Cardiology::06_Blood_Pressure::06_Shock:_Cardiogenic_&_Obstructive_SOAPs #AK_Step2_v12::!Shelf::IM #AK_Step1_v12::^Systems::Cardio::Pathology