Silent Mitral Insufficiency in Acute Myocardial Infarction
| Autor: | Howard N. Allen, Jack M. Matloff, Sheldon I. Freedman, H.J.C. Swan, George A. Diamond, James S. Forrester, William W. Parmley |
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| Rok vydání: | 1971 |
| Předmět: |
Male
Cardiac Catheterization medicine.medical_specialty Heart disease Myocardial Infarction Stimulation Coronary Circulation Physiology (medical) Internal medicine medicine Humans Mitral valve prolapse cardiovascular diseases Myocardial infarction Cardiac Output Papillary muscle Aged business.industry Cardiogenic shock Angiocardiography Hemodynamics Mitral Valve Insufficiency Middle Aged Papillary Muscles medicine.disease medicine.anatomical_structure Heart failure Circulatory system cardiovascular system Cardiology Cardiology and Cardiovascular Medicine business Heart Auscultation |
| Zdroj: | Circulation. 44:877-883 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/01.cir.44.5.877 |
| Popis: | Severe mitral insufficiency in the absence of an audible murmur was diagnosed by left ventricular angiography in three patients with power failure secondary to acute myocardial infarction during evaluation for mechanical circulatory assist and surgery. Mitral valve prolapse was present in two patients. Postmortem examination did not reveal an anatomic basis for the mitral insufficiency: the valve, papillary muscles, and supporting structures were all grossly normal. A single papillary muscle removed at surgery revealed a marked decrease in force development (0.22 g/mm 2 vs 0.62 ± 0.22 g/mm 2 in eight normal papillary muscles from patients with rheumatic heart disease). During isoproterenol stimulation, force development in this muscle decreased 20%, whereas in the normal muscles force development increased 73 ± 31%. Microscopically, all papillary muscles revealed evidence of extensive necrosis. Silent mitral insufficiency in acute myocardial infarction, therefore, was probably related to diminished flow velocity across the mitral valve secondary to diminished myocardial contractility. Failure to recognize and treat this entity may contribute significantly to the genesis of power failure and ultimate mortality. |
| Databáze: | OpenAIRE |
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