Papillary muscle dysfunction

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Related Key Words and Synonyms:

Pathophysiology & Etiology

Left ventricular papillary muscles are perfused by the terminal portion of the coronary vascular bed, therefore, they are particularly vulnerable to ischemia, and any disturbance in coronary perfusion may result in papillary muscle dysfunction.

The posterior papillary muscle (supplied by the posterior descending branch of the right coronary artery) more frequently becomes ischemic and infarcted than the anterolateral papillary muscle (supplied by diagonal branches of the left anterior descending coronary artery and/or by the left circumflex artery).

Burch classification

Burch et al first proposed that papillary muscle dysfunction could be due to either mitral valve prolapse or incomplete mitral valve closure

• Papillary muscle ischemia.
• Left ventricular dilatation.
• Non ischemic papillary muscle atrophy.
• Congenital abnormalities of papillary muscles or tendons.
• Endocardial diseases (endocarditis, fibroelastosis).
• Expansion or hypertrophic cardiomyopathy.
• Papillary muscle contraction coordination abnormalities.
• Papillary muscle or tendon rupture.

Diagnosis

History and Symptoms

Palpitations, shortness of breath and cough.

Physical Examination

• Acute onset of hypotension is present.

Heart

• Hyperactive precordium is present
• Loud mid-to-late systolic or holosystolic murmur is present

Lungs

• Pulmonary edema may also be present

Laboratory Findings

Electrocardiogram

Left atrial enlargement or non specific ST segment and T wave changes may occur.

Chest X Ray

Left atrial enlargement may be present

Echocardiography and Doppler Ultrasound

• Two dimensional electrocardiograph may show changes in thickness of papillary muscle, an increase in leaflet flexibility, ventricular dilatation and tendon rupture if there is any.

• Doppler US may detect mitral regurgitating flow