Papillary muscle dysfunction

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Related Key Words and Synonyms:

Left ventricular papillary muscles are perfused by the terminal portion of the coronary vascular bed, therefore, they are particularly vulnerable to ischemia, and any disturbance in coronary perfusion may result in papillary muscle dysfunction.

The posterior papillary muscle (supplied by the posterior descending branch of the right coronary artery) more frequently becomes ischemic and infarcted than the anterolateral papillary muscle (supplied by diagonal branches of the left anterior descending coronary artery and/or by the left circumflex artery).

Burch et al first proposed that papillary muscle dysfunction could be due to either mitral valve prolapse or incomplete mitral valve closure^[1]

• Papillary muscle ischemia.
• Left ventricular dilatation.
• Non ischemic papillary muscle atrophy.
• Congenital abnormalities of papillary muscles or tendons.
• Endocardial diseases (endocarditis, fibroelastosis).
• Expansion or hypertrophic cardiomyopathy.
• Papillary muscle contraction coordination abnormalities.
• Papillary muscle or tendon rupture.

Palpitations, shortness of breath and cough.

• Acute onset of hypotension is present.

• Hyperactive precordium is present
• Loud mid-to-late systolic or holosystolic murmur is present

• Pulmonary edema may also be present

Left atrial enlargement or non specific ST segment and T wave changes may occur.

Left atrial enlargement may be present

• Two dimensional electrocardiograph may show changes in thickness of papillary muscle, an increase in leaflet flexibility, ventricular dilatation and tendon rupture if there is any.

• Doppler US may detect mitral regurgitating flow ^[2]

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