An 82-year-old woman with no significant past medical history presented to the emergency room in cardiogenic shock. After the patient was stabilized with mechanical ventilation and vasoactive medications, an emergency echocardiogram was performed. Figure⇓ A is a subcostal four-chamber echocardiographic view of the heart, which reveals rupture of the head of the anterolateral papillary muscle. Fig B, apical four-chamber echocardiographic view, shows the ruptured papillary muscle; note that the head remains attached to the mitral valve. The ruptured head was noted to prolapse freely into the left atrium, and severe mitral regurgitation was present. After discussion with the patient’s family and in accordance with a preexisting living will, further resuscitative efforts were not made, and the patient died shortly thereafter. Postmortem examination revealed a large acute anterolateral myocardial infarction with rupture of the anterolateral papillary muscle (see Fig C).
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC 4-265, Houston, TX 77030.
- Copyright © 1997 by American Heart Association