Pseudo-endocarditis secondary to ruptured posteromedial papillary muscle with anatomical variation: A Case Report


Pseudo-endocarditis secondary to ruptured posteromedial papillary muscle with anatomical variation: A Case Report


Natassja Moriarty, MBBS1*; Jonathan Moriarty, MBBS2; Nadeem Attar,MBBS3; Adrian Brodison, MB chB4

1,2Department of Medicine, Furness General Hospital.
3,4Consultant Cardiologist, Furness General Hospital.


Myocardial infarction is the leading cause of papillary muscle rupture. This complication occurs in up to 5% of cases post MI and although rare, it constitutes a cardiac emergency if left untreated.

On this basis, a 59-year-old male presented with low-grade fever and atypical chest pain with raised inflammatory markers and troponin levels.  He was treated for infective endocarditis after echocardiography revealed a mass on the mitral valve, which was presumed to be a mitral valve vegetation and so he completed a 6-weeks course of antibiotics followed by elective mitral valve replacement surgery.

During surgery, it was discovered that there was no endocarditis. Instead an unusually small muscle head of one of the posteromedial papillary muscle groups had ruptured secondary to an inferior myocardial infarction. This ruptured muscle head was highly mobile and mimicked a mitral valve vegetation. The mitral valve was successfully repaired, and the right coronary artery grafted.

He made a full recovery but developed new-onset atrial fibrillation for which he is awaiting elective cardioversion.

One should have a high index of suspicion for diagnosing papillary muscle rupture as it may mimic valvular vegetation on echocardiography, especially if the papillary muscle involved is an anatomical variant.


Keywords: Papillary muscle, rupture, endocarditis, mitral valve


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How to cite this article:

Natassja Moriarty,Jonathan, Moriarty, Nadeem Attar, Adrian Brodison. Pseudo-endocarditis secondary to ruptured posteromedial papillary muscle with anatomical variation: A Case Report. International Journal of Case Reports, 2020; 4:179. DOI: 10.28933/ijcr-2020-11-0105


References:

1. Filho ATP et al. Anterolateral Papillary Muscle Rupture in a Patient with Infectious Endocarditis and Rheumatic Mitral Disease: Case Report Rev bras echocardiogr imagem cardiovasc. 2013; 26(3):223-227. Available from: http://departamentos.cardiol.br/dic/publicacoes/revistadic/revista/2013/ingles/Revista03/11-relato-ruptura.pdf
2. Rajiah P, Fulton N, Bolen M. Magnetic resonance imaging of the papillary muscles of the left ventricle: normal anatomy, variants, and abnormali-ties. Insights Imaging. 2019;10(1).doi:10.1186/s13244-019-0761-3
3. Moustapha A, Lyngholm K, Barasch E. Isolated Acute Anterolateral Papillary Muscle Rupture Presenting as a Sole Manifestation of Acute Myocardial Infarction and Mimicking Mitral Valve Vegetation. Cardiology. 2001; 96(1):53-56.doi:10.1159/000047387
4. Saha A, Roy S. Papillary muscles of left ventricle—Morphological variations and it’s clinical relevance. Indian Heart J. 2018;70(6):894-900. doi: 10.1016/j.ihj.2017.12.003
5. Madu E, D’Cruz I. The vital role of papillary muscles in mitral and ventricular function: echocardiographic insights. Clin Cardiol. 1997;20(2):93-98. doi:10.1002/clc.4960200203
6. Czarnecki A, Thakrar A, Fang T et al. Acute severe mitral regurgitation: consideration of papillary muscle architecture. Cardiovasc Ultrasound. 2008;6(1). doi:10.1186/1476-7120-6-5
7. Navinan M, Mendis S, Wickramasinghe S, Kathirgamanathan A, Fernando T, Yudhisdran J. Inflammation in ST- elevation myocardial infarction: risk factors, patterns of presentation and association with clinical picture and outcome, an observational study conducted at the Institute of Cardiology-National Hospital of Sri Lanka. BMC Cardiovasc Disord. 2019;19(1).doi:10.1186/s12872-019-1104-5


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