SOME NEW OBSERVATIONS ON SYNDROME OF PAPILLARY MUSCLE DYSFUNCTION

Papillary muscle dysfunction is a common accompaniment of coronary artery disease, equally frequent in association with anterior and posterior myocardial infarct or ischemia. The murmur of papillary muscle dysfunction may either be transient during acute myocardial infarction or angina pectoris or be a permanent feature of the syndrome. Although the typical murmur of papillary muscle dysfunction as originally described by Burch and associates is midsystolic and ejection in type, it can often be pansystolic or late systolic, thus indistinguishable from that due to other forms of mitral regurgitation. Diastolic and presystolic gallops are frequently present, usually without any clinical evidence of heart failure. The first heart sound is usually accentuated, even in the presence of a prolonged P-R or QRS interval. The triad of an accentuated first sound, systolic murmur and presystolic and diastolic gallops, especially in the absence of congestive heart failure, should strongly suggest the diagnosis of papillary muscle dysfunction. Additional clinical features that distinguish the murmur of papillary muscle dysfunction from other forms of mitral regurgitation are postextrasystolic decrease of the intensity of the systolic murmur and inspiratory increase of the gallop and first sound. Ventricular aneurysm is a rather frequent complication of papillary muscle dysfunction. In patients with the advanced form of the disease surgical therapy may be indicated if congestive heart failure results from either severe mitral regurgitation or large ventricular aneurysm associated with papillary muscle dysfunction. © 1969.