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The American Journal of Medicine Dec 2022Mechanical complications of myocardial infarction include rupture of a papillary muscle, ventricular septum, and free wall. Since the advent of acute coronary... (Review)
Review
Mechanical complications of myocardial infarction include rupture of a papillary muscle, ventricular septum, and free wall. Since the advent of acute coronary reperfusion, there has been a significant reduction in the incidence of these complications. One must have a high index of suspicion for a mechanical complication in any patient who develops cardiogenic shock in the days following a myocardial infarction. The most important diagnostic investigation in evaluation of these complications is echocardiography. Although there is a role for mechanical circulatory support, urgent surgical repair is required in most cases. We will review the predictors, clinical features, diagnostic, and management strategies in patients with these complications.
Topics: Humans; Myocardial Reperfusion; Myocardial Infarction; Shock, Cardiogenic; Echocardiography; Ventricular Septum
PubMed: 36075485
DOI: 10.1016/j.amjmed.2022.08.017 -
Circulation Sep 2019Despite a 2% to 3% prevalence of echocardiographically defined mitral valve prolapse (MVP) in the general population, the actual burden, risk stratification, and... (Review)
Review
Despite a 2% to 3% prevalence of echocardiographically defined mitral valve prolapse (MVP) in the general population, the actual burden, risk stratification, and treatment of the so-called arrhythmic MVP are unknown. The clinical profile is characterized by a patient, usually female, with mostly bileaflet myxomatous disease, mid-systolic click, repolarization abnormalities in the inferior leads, and complex ventricular arrhythmias with polymorphic/right bundle branch block morphology, without significant regurgitation. Among the various pathophysiologic mechanisms of electrical instability, left ventricular fibrosis in the papillary muscles and inferobasal wall, mitral annulus disjunction, and systolic curling have been recently described by pathological and cardiac magnetic resonance studies in sudden death victims and patients with arrhythmic MVP. In addition, premature ventricular beats arising from the Purkinje tissue as ventricular fibrillation triggers have been documented by electrophysiologic studies in MVP patients with aborted sudden death. The genesis of malignant ventricular arrhythmias in MVP probably recognizes the combination of the substrate (regional myocardial hypertrophy and fibrosis, Purkinje fibers) and the trigger (mechanical stretch) eliciting premature ventricular beats because of a primary morphofunctional abnormality of the mitral valve annulus. The main clinical challenge is how to identify patients with arrhythmic MVP (which imaging technique and in which patient) and how to treat them to prevent sudden death. Thus, there is a necessity for prospective multicenter studies focusing on the prognostic role of cardiac magnetic resonance and electrophysiologic studies and on the therapeutic efficacy of targeted catheter ablation and mitral valve surgery in reducing the risk of life-threatening arrhythmias, as well as the role of implantable cardioverter defibrillators for primary prevention.
Topics: Catheter Ablation; Death, Sudden; Humans; Mitral Valve Prolapse; Papillary Muscles; Ventricular Fibrillation
PubMed: 31498700
DOI: 10.1161/CIRCULATIONAHA.118.034075 -
Arrhythmia & Electrophysiology Review Apr 2022Mitral valve prolapse (MVP) is a common condition present in 1-3% of the population. There has been evidence that a subset of MVP patients is at higher risk of sudden... (Review)
Review
Mitral valve prolapse (MVP) is a common condition present in 1-3% of the population. There has been evidence that a subset of MVP patients is at higher risk of sudden cardiac death. The arrhythmogenic mechanism is related to fibrotic changes in the papillary muscles caused by the prolapsing valve. ECG features include ST-segment depression, T wave inversion or biphasic T waves in inferior leads, and premature ventricular contractions arising from the papillary muscles and the fascicular system. Echocardiography can identify MVP and mitral annular disjunction, a feature that has significant negative prognostic value in MVP. Cardiac MRI is indicated for identifying fibrosis. Patients with high-risk features should be referred for further evaluation. Catheter ablation and mitral valve repair might reduce the risk of malignant arrhythmia. MVP patients with high-risk features and clinically documented ventricular arrhythmia may also be considered for an ICD.
PubMed: 35990107
DOI: 10.15420/aer.2021.28 -
Journal of Nuclear Cardiology :... Feb 2022
Topics: Ammonia; Coronary Circulation; Humans; Ischemia; Myocardial Ischemia; Myocardial Perfusion Imaging; Nitrogen Radioisotopes; Papillary Muscles; Positron-Emission Tomography; Tomography, Emission-Computed
PubMed: 32909237
DOI: 10.1007/s12350-020-02336-5 -
European Heart Journal Nov 2019
Topics: Aged; Cardiomyopathies; Echocardiography, Transesophageal; Fatal Outcome; Female; Humans; Imaging, Three-Dimensional; Mitral Valve Insufficiency; Papillary Muscles; Rupture, Spontaneous
PubMed: 31377807
DOI: 10.1093/eurheartj/ehz549