Diagnosis and management of papillary muscle rupture complicating acute myocardial infarction: A case report and review of the literature

Introduction: The incidence of mechanical complications related to myocardial infarction has decreased over the last decades, and revascularization certainly plays a major role in this change. However, mortality still remains elevated. This is a case of acute papillary muscle rupture secondary to myocardial infarction leading to cardiogenic shock. Case Presentation: A 71-year-old woman presented to an outside hospital complaining of chest pain and shortness of breath. An electrocardiogram was obtained and revealed depression of the ST segments from leads V1 to V4. Troponin I was elevated at 3.0 ng/mL. She was transferred to our facility for a higher level of care. She was found in cardiogenic shock at arrival. A bedside echocardiogram was ordered, which demonstrated papillary muscle rupture with severe mitral regurgitation. A coronary angiogram followed, which diagnosed severe three-vessel disease. After the insertion of an intra-aortic balloon pump, she was transferred emergently to the surgical suite for mitral valve replacement and revascularization. The operation was uneventful. She was discharged to a rehabilitation center after approximately 1 month of hospital stay. Conclusions: Mortality from papillary muscle rupture remains elevated. Survival largely depends on the early surgical repair or the replacement of the mitral valve.