0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18
Papillary Muscle Dysfunction and Rupture 1131➣Enzymes normal with ischemia and transient papillary muscle
dysfunction
■Chest X-Ray
➣Heart size may be normal
➣Normal size left atrium
➣Pulmonary venous congestion present
■Echo/Doppler
➣Detect and quantitate MR
➣Flail mitral valve leaflet may be visualized after rupture
➣Detect left ventricular (LV) wall motion abnormality
➣Assess LV dimensions (usually normal for acute MR)
➣Assess LV function (may be normal pending othe conditions)
■Cardiac Catheterization
➣Prominent V wave in pulmonary capillary wedge pressure
➣Low cardiac output and index
➣Detect and quantitate mitral regurgitation during left ventricu-
lography
➣Wall motion abnormality present on left ventriculogram
➣Detect high grade/total occlusion of vessel (usually the right
coronary artery) and presence of other coronary stenoses by
coronary angiography
differential diagnosis
■Ventricular septal defect
management
Medical
■Afterload reduction therapy with vasodilators
■Intra-aortic balloon pump for hypotension
specific therapy
■Surgical repair/replacement of mitral valve with coronary revascu-
larization (usually surgical emergency) See discussion under Mitral
Insufficiency
follow-up
n/a
complications and prognosis
Complications – see section Mitral InsufficiencyPrognosis
■Depends on co-existing CAD and LV function
■See section Mitral Insufficiency