papillary muscle insufficiency
Introduction
Introduction to papillary muscle dysfunction Papillary muscle dysfunction refers to papillary muscle attached to the atrioventricular valve chordae due to ischemia, necrosis, fibrosis or other causes of systolic dysfunction, resulting in mitral regurgitation, resulting in mitral regurgitation. The posterior medial papillary muscle is supplied by the circumflex artery of the left coronary artery. Therefore, the posterior medial papillary muscle is more common than the anterior lateral papillary muscle. Papillary muscle rupture occurs mostly 5 to 7 days after acute myocardial infarction, and a few within 3 weeks. Posterior medial papillary muscle rupture is common in acute penetrating inferior myocardial infarction, and anterior lateral papillary muscle rupture is the consequence of acute anterior wall myocardial infarction. basic knowledge Sickness ratio: 0.0012% Susceptible people: no specific population Mode of infection: non-infectious Complications: acute pulmonary edema, cardiogenic shock
Cause
Causes of papillary muscle dysfunction
There are many causes of papillary muscle dysfunction, and the causes are classified as:
1 papillary muscle ischemia, 2 left ventricular dilatation, 3 papillary muscle non-ischemic atrophy, 4 papillary muscle or chordae congenital anomaly, 5 endocardial diseases, 6 dilated or hypertrophic cardiomyopathy, 7 papillary muscle contraction coordination Sexual destruction, 8 papillary muscles or chordae rupture.
Papillary muscle dysfunction is more common in coronary heart disease, acute myocardial ischemia and chronic myocardial interstitial fibrosis can be caused, acute ischemia or necrosis of papillary muscles, partial nipcap contractile dysfunction; ventricular wall tumor formation, during systole Relative movement occurs, so that the papillary muscle of the corresponding part pulls the mitral valve leaf into the ventricular cavity, and the papillary muscle breaks, so that the mitral valve leaf loses traction force during systole and turns back to the left atrium, which will produce serious two. The cusp is incompletely closed and severe mitral regurgitation occurs.
Prevention
Papillary muscle dysfunction prevention
(1) Actively adopt various methods such as thrombolysis, emergency coronary angioplasty, bypass grafting, etc., so that the occluded coronary artery can be recanalized as soon as possible to save the sudden death of the myocardium and effectively limit or reduce the infarct size.
(2) Maintain blood pressure stability. In the case of hypotension and shock, the AMI should strictly control the concentration and rate of blood pressure, so that the blood pressure can rise steadily to an appropriate level, avoid sudden and large fluctuations in blood pressure. If you need high blood pressure to use antihypertensive drugs, you can use intravenous antihypertensive drugs with quick onset and fast disappearance. Avoid using antihypertensive drugs with slow onset and long-acting effects.
(3) Keep the stool smooth and avoid using stools. Absolute bed rest in the acute phase to avoid fatigue or body and activity.
(4) Reasonable application of anticoagulant therapy In the absence of conditions for thrombolysis or emergency coronary angioplasty, if there is no contraindication to anticoagulant therapy, heparin may be given early to prevent infarction, but should prevent overdose . If there is a pericardial friction sound, the anticoagulant should be stopped in time.
Complication
Papillary muscle dysfunction complications Complications acute pulmonary edema cardiogenic shock
Acute papillary muscle ischemia or chordae rupture suddenly a large number of mitral regurgitation, often acute pulmonary edema and cardiogenic shock.
Symptom
Papillary muscle dysfunction symptoms Common symptoms Short-term palpitations, systolic murmur, angina pectoris, diastolic, cerebral palpebral muscle, rupture, chordae rupture
symptom:
Mild symptoms can be asymptomatic, papillary muscle injury is obvious, and the reflux flow can be palpitations, shortness of breath, cough, etc., acute papillary muscle ischemia or chordae rupture suddenly a large number of mitral regurgitation, often acute pulmonary edema and Cardiogenic shock.
Signs:
The apical systolic murmur is the most important sign of the disease. The papillary muscle dysfunction accompanied by angina pectoris changes. The systolic miscellaneous sound of the apex changes with the onset of angina. The murmur of acute papillary muscle rupture has a sudden full systole. And rough features, often accompanied by diastolic gallop or fourth heart sound.
Examine
Examination of papillary muscle dysfunction
First, the ECG:
There may be ST-T changes, but no specificity. The anterior papillary muscle involvement is usually associated with anterior myocardial infarction, so ST-T changes occur in I, avl, v5, v6 leads, and the posterior papillary muscles are involved. In the posterior wall, inferior myocardial infarction, ST-T changes are seen in II, III, avF and other leads.
Second, echocardiography:
Two-dimensional echocardiography shows that the thickness and elasticity of the mitral leaflets are normal, the amplitude of the valve leaflets is small, the valve orifice is small, the distance between the mitral valve and the interventricular septum is increased, and the chordae tendine can be detected or not. Ultrasound Doppler The diagnostic meter can detect the amount of return flow.
Third, X-ray inspection:
There is often a left atrium, the left ventricle is enlarged, and left ventricular angiography is seen with mitral regurgitation.
Diagnosis
Diagnosis and diagnosis of papillary muscle dysfunction
Diagnosis of acute papillary muscle dysfunction:
1 After the onset of acute myocardial infarction or severe angina pectoris, systolic murmur of grade III or above appears at the apex to the underarm.
2 The degree of systolic murmur (and systolic click), the nature is variable, and there are S3 gallop and fourth heart sound.
3 After the use of isoamyl nitrite, the systolic murmur can be weakened; the systolic murmur of the chin test can be enhanced.
4 left ventricular angiography is the most diagnostic value, and echocardiography is also helpful.
It should mainly identify different diseases of the systolic new sound in the precordial area, as well as different diseases that cause mitral regurgitation. For example, the systolic new sound in the anterior region is not necessarily mitral regurgitation, such as congenital atrioventricular septum. Defects, hypertrophic cardiomyopathy, straight syndrome, etc. In addition, there are many diseases that cause mitral regurgitation, such as rheumatic mitral regurgitation, mitral valve prolapse, senile mitral valve Calcification, indirectly caused by mitral regurgitation, left ventricular enlargement caused by any cause, rupture of the nipple tendon and so on.
