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:

Epidemiology and Demographics

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[1]

Natural History

Diagnosis

Differential Diagnosis

History and Symptoms

Palpitations, shortness of breath and cough.

Physical Examination

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 [2]

Treatment

Pharmacotherapy

Acute Pharmacotherapies

Chronic Pharmacotherapies

Surgery and Device Based Therapy

Indications for Surgery

References

  1. Burch GE, De Pasquale NP, Phillips JH. The syndrome of Papillary Muscle Dysfunction Am Heart J 75: 399-415, 1968
  2. Ogawa S, Hubbard FE, Mardelli TJ, Dreifus LS. Cross sectional echocardiographic spectrum of papillary muscle dysfunction Am Heart J 97, 312-321, 1979



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