Papillary muscle rupture

The most important mechanical complications of ACS evolving to MI occur in transmural infarctions, usually Q-wave infarction. They consist in cardiac rupture, which may occur in the free wall, the interventricular septum or the papillary muscles and the ventricular aneurisms. 

Figure 8.29 (A) Rupture of inferior wall in a patient after 7 days of inferior Ml due to LCX occlusion. See the echocardiography with great haematic pericardial effusion and the pathological aspect of the rupture. In spite of that, the ECG shows relatively small ECG changes (mild ST-segment elevation in I and VL and mirror image of ST-segment depression in V1-V3 that remains after a week of Ml). (B) Rupture of posteromedial papillary muscle (see...

Formation of vegetations may destroy valvular tissue, and continued destruction can lead to acute heart failure via perforation of the valve leaflet, rupture of the chordae tendineae or papillary muscle, or in the patient with PVE, valve dehiscence. Occasionally, valvular stenosis may occur. Abscesses can develop in the valve ring or in myocardial tissue itself. Even with resolution of the process, fibrosis of tissue with some residual dysfunction is possible. 

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