Introduction
Papillary muscle rupture is one of the rare and potentially
life-threatening
complication usually following acute myocardial infarction (AMI). Acute
and complete papillary muscle rupture (PMR) results in severe mitral
regurgitation rapidly progressing to florid pulmonary edema and
cardiogenic shock.1 Without emergent surgical
intervention, the mortality is extremely high.
We present an unusual case of 56
years old male who presented with acute
inferior wall myocardial infarction (IWMI) and underwent successful
thrombolysis but unfortunately, developed reinfarction 5 days later
complicated by acute postero-medial papillary muscle rupture (PPMR)
leading to severe acute mitral regurgitation. He was promptly diagnosed
and underwent emergent mitral valve replacement.
Key words: COVID - 19, Mitral regurgitation, papillary muscle rupture,
Acute myocardial infarction.
CASE PRESENTATION
A 56-year-old smoker not known to have any medical illness presented to
us
with progressive chest pain of one-hour duration. Initial
electrocardiogram
(ECG) showed inferior leads ST segment elevation (STE) with reciprocal
changes in anterior leads (figure 1A) and ST elevation (STE) in right
V4R suggestive of acute inferior and right ventricular current of
injury. His systemic examination was unremarkable. Peak highly sensitive
troponin I assay was >25 (Normal range <0.010)
and creatine kinase (CK) level 4764 (Normal range 20 – 200 IU/L).
Based on our institutional protocol in this current covid-19 era, he
underwent
thrombolysis with Tenecteplase. His event was complicated with transient
hypotension and heart block which resolved spontaneously. He had
successful
thrombolysis with significant resolution of STE (figure 1B) and chest
pain free
60 minutes post administration of Tenecteplase.
He was managed conservatively on dual anti-platelet therapy and statin.
His
GeneXpert test for SARS COV 2 turned out to be positive without any
significant constitutional symptoms. He was admitted to COVID 19
intensive
care unit with full cardiac monitoring.
A B