Papillary muscle dysfunction

Overview papillary muscle dysfunction refers atrioventricular valve tendons are attached to the papillary muscles due to ischemia, necrosis, fibrosis or other reasons, caused systolic dysfunction, resulting in mitral regurgitation, mitral regurgitation have. Etiology and pathophysiology caused papillary muscle dysfunction has many causes, the causes of vaginal ① classified as papillary muscle ischemia. ② dilated left ventricle. ③ non-ischemic papillary muscle atrophy. ④ papillary muscles or tendons congenital anomalies. ⑤ endocardial diseases (endocarditis, fibroelastosis). ⑥ expansion or hypertrophic cardiomyopathy. ⑦ papillary muscle contraction coordination damage. ⑧ papillary muscle or tendon rupture. Papillary muscle dysfunction is more common in coronary heart disease, acute myocardial ischemia (angina, myocardial infarction) and chronic myocardial fibrosis can be caused. Papillary muscle, or acute ischemic necrosis, some papillary muscle contraction dysfunction; Heart aneurysm formation, in systolic have relative movement, the corresponding parts of the papillary muscles will stretch to the mitral leaf chamber, papillary muscle rupture. so that leaves the mitral ventricular systolic lost traction force and turned back to the left atrium, all will have serious mitral regurgitation. and the occurrence of severe mitral regurgitation. A clinical performance, the mild symptoms can be asymptomatic, papillary muscle injury obviously, back to the greater flow may have heart palpitations, shortness of breath, cough. Papillary muscle acute ischemic or RMCT sudden large mitral regurgitation, often acute pulmonary edema and cardiogenic shock. 2, signs apical systolic murmur of the disease is the most important signs. Angina With the papillary muscle dysfunction, the apical systolic murmur loudness with angina attack changes. Acute papillary muscle rupture with the noise suddenly appeared in all the systolic and rough features, accompanied diastolic Benma legal or fourth heart sounds. Laboratory and one other inspection, ECG can ST-T changes, but no specificity, Before papillary muscle with the general involved in the anterior wall myocardial infarction, the ST-T changes were seen in the I, avl, v5. v6 such as lead. After the papillary muscles associated with more involvement in the wall, under the wall myocardial infarction, ST-T changes found in the II, III, etc. electrocardogram lead. 2, echocardiography two-dimensional echocardiography showed mitral leaf thickness and flexibility for normal valve leaflets small margin activities, small valve, mitral and ventricular septal distance increased, tendons can be unearthed any fracture, Doppler ultrasound diagnostic apparatus can detect flow back to the size. 3, X-ray examination often left atrium and left ventricle increased left ventricular angiography see a mitral regurgitation. Diagnosis of acute papillary muscle dysfunction diagnosis : ① acute myocardial infarction or severe angina pectoris, Ⅲ apex appears above the level of systolic murmur conduction to the armpit. ② systolic murmur (and systolic and Kara Music) on the extent, nature variable and may have a legal S3 Benma and fourth heart sounds. ③ the use of nitrite isoamyl acetate, systolic murmur may decline; Squatting test can boost systolic murmur. ④ left ventricular angiography most diagnostic value of echocardiography examination also helped. A treatment, the treatment causes medical treatment, such as coronary heart disease patients improved myocardial ischemia. angina relief measures are conducive to the acute papillary muscle dysfunction recovery. Reflux severe heart failure can occur vasodilator. 2, surgical treatment of papillary muscle rupture or chronic papillary lesions serious tendon REQUEST mitral regurgitation significantly, should consider valve replacement or repair of mitral annular papillary muscle and suturing, a higher surgical mortality.