Prompt diagnosis of ST-elevation myocardial infarction with papillary muscle rupture by point-of-care ultrasound in the emergency department
A previously healthy 61-year-old man presented to the emergency department with chest pain and dyspnoea for 6 hours. Examination revealed distress with an apical pansystolic murmur. Initial electrocardiogram showed sinus tachycardia and ST elevation in leads II, III, and aVF compatible with an infer...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
The Korean Society of Emergency Medicine
2017-09-01
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| Series: | Clinical and Experimental Emergency Medicine |
| Subjects: | |
| Online Access: | http://www.ceemjournal.org/upload/pdf/ceem-16-172.pdf |
| _version_ | 1797895599014543360 |
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| author | Koon Ho Cheung Colin Graham Alexander |
| author_facet | Koon Ho Cheung Colin Graham Alexander |
| author_sort | Koon Ho Cheung |
| collection | DOAJ |
| description | A previously healthy 61-year-old man presented to the emergency department with chest pain and dyspnoea for 6 hours. Examination revealed distress with an apical pansystolic murmur. Initial electrocardiogram showed sinus tachycardia and ST elevation in leads II, III, and aVF compatible with an inferior ST-elevation myocardial infarction. Point-of-care echocardiography in the emergency department showed a flail anterior mitral leaflet and severe mitral regurgitation, leading to a provisional diagnosis of papillary muscle rupture. Emergency cardiac catheterization showed 100%, 80%, and 70% occlusion of the middle right coronary, left anterior descending, and left circumflex arteries, respectively. An emergency triple vessel coronary artery bypass grafting and mitral valve replacement was performed. Posteromedial papillary muscle rupture resulting in mitral regurgitation was confirmed intraoperatively. The patient recovered uneventfully. In the absence of primary percutaneous coronary intervention, thrombolysis decisions should be made with extreme caution if mechanical complications of ST-elevation myocardial infarction are suspected. |
| first_indexed | 2024-04-10T07:29:29Z |
| format | Article |
| id | doaj.art-20a2d602ab9245efbacc6e4a90b2b875 |
| institution | Directory Open Access Journal |
| issn | 2383-4625 |
| language | English |
| last_indexed | 2024-04-10T07:29:29Z |
| publishDate | 2017-09-01 |
| publisher | The Korean Society of Emergency Medicine |
| record_format | Article |
| series | Clinical and Experimental Emergency Medicine |
| spelling | doaj.art-20a2d602ab9245efbacc6e4a90b2b8752023-02-24T00:01:38ZengThe Korean Society of Emergency MedicineClinical and Experimental Emergency Medicine2383-46252017-09-014317818110.15441/ceem.16.172148Prompt diagnosis of ST-elevation myocardial infarction with papillary muscle rupture by point-of-care ultrasound in the emergency departmentKoon Ho Cheung0Colin Graham Alexander1 Accident and Emergency Department, Prince of Wales Hospital, Hong Kong Accident and Emergency Department, Prince of Wales Hospital, Hong KongA previously healthy 61-year-old man presented to the emergency department with chest pain and dyspnoea for 6 hours. Examination revealed distress with an apical pansystolic murmur. Initial electrocardiogram showed sinus tachycardia and ST elevation in leads II, III, and aVF compatible with an inferior ST-elevation myocardial infarction. Point-of-care echocardiography in the emergency department showed a flail anterior mitral leaflet and severe mitral regurgitation, leading to a provisional diagnosis of papillary muscle rupture. Emergency cardiac catheterization showed 100%, 80%, and 70% occlusion of the middle right coronary, left anterior descending, and left circumflex arteries, respectively. An emergency triple vessel coronary artery bypass grafting and mitral valve replacement was performed. Posteromedial papillary muscle rupture resulting in mitral regurgitation was confirmed intraoperatively. The patient recovered uneventfully. In the absence of primary percutaneous coronary intervention, thrombolysis decisions should be made with extreme caution if mechanical complications of ST-elevation myocardial infarction are suspected.http://www.ceemjournal.org/upload/pdf/ceem-16-172.pdfmyocardial infarctionpapillary muscle rupturepoint-of-care ultrasoundechocardiographyemergency service, hospital |
| spellingShingle | Koon Ho Cheung Colin Graham Alexander Prompt diagnosis of ST-elevation myocardial infarction with papillary muscle rupture by point-of-care ultrasound in the emergency department Clinical and Experimental Emergency Medicine myocardial infarction papillary muscle rupture point-of-care ultrasound echocardiography emergency service, hospital |
| title | Prompt diagnosis of ST-elevation myocardial infarction with papillary muscle rupture by point-of-care ultrasound in the emergency department |
| title_full | Prompt diagnosis of ST-elevation myocardial infarction with papillary muscle rupture by point-of-care ultrasound in the emergency department |
| title_fullStr | Prompt diagnosis of ST-elevation myocardial infarction with papillary muscle rupture by point-of-care ultrasound in the emergency department |
| title_full_unstemmed | Prompt diagnosis of ST-elevation myocardial infarction with papillary muscle rupture by point-of-care ultrasound in the emergency department |
| title_short | Prompt diagnosis of ST-elevation myocardial infarction with papillary muscle rupture by point-of-care ultrasound in the emergency department |
| title_sort | prompt diagnosis of st elevation myocardial infarction with papillary muscle rupture by point of care ultrasound in the emergency department |
| topic | myocardial infarction papillary muscle rupture point-of-care ultrasound echocardiography emergency service, hospital |
| url | http://www.ceemjournal.org/upload/pdf/ceem-16-172.pdf |
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