Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1130 Pancreatic Cysts Papillary Muscle Dysfunction and Rupture

■observation is sometimes chosen over surgical resection. These

patients are followed with serial CT scans to monitor any change

in the cysts.

complications and prognosis

■Prognosis is excellent for serous cystadenomas

■Resected mucinous cystadenocarcinomas possess better 5-year sur-

vival rates than the more common adenocarcinomas.

■unresectable mucinous tumors carry a poor prognosis

PAPILLARY MUSCLE DYSFUNCTION AND RUPTURE

JUDITH A. WISNESKI, MD

history & physical

History

■Myocardial ischemia and infarction (most common)

➣Rupture of posterior papillary muscle with infarction of right

coronary artery (most common); rupture of anterolateral pap-

illary muscle with infarction of diagonal or obtuse marginal

branches off left coronary artery (less frequent)

■Severe anemia

■Shock

■Trauma

Signs & Symptoms

■Transient mid or late systolic or holosystolic heart murmur and pul-

monary congestion during angina (papillary muscle dysfunction

during ischemia)

■Pulmonary congestion or acute pulmonary edema with new heart

murmur (holosystolic or mid systolic) following an acute MI (papil-

lary muscle rupture)

■Hypotension may be present; cardiogenic shock can occur

tests

■ECG

➣ST and T wave changes of ischemia or infarction

➣New Q waves may be present (usually present prior to rupture)

■Blood

➣Elevation of troponin I and other cardiac enzymes prior to rup-

ture of papillary muscle (enzyme elevation may be small)