A 73-year-old woman in cardiogenic shock was referred to our hospital because of papillary muscle rupture immediately after the onset of acute myocardial infarction (MI). She had undergone emergent percutaneous coronary intervention and mitral valve replacement. Serial creatine kinase and creatine kinase MB levels indicated that she had acute phase MI on arrival. Pathological findings showed coagulative necrosis of the papillary muscle, which was characteristic evidence of the consequence of prolonged ischemia. We describe herein an unusual case of complete rupture of the posterior papillary muscle occurring immediately after the development of MI. <Learning objective: Mechanical complications of acute myocardial infarction (AMI) such as left ventricular free wall rupture, interventricular wall rupture, and papillary muscle rupture (PMR) commonly occur 2 to 7 days after the onset of AMI. We describe a case of PMR immediately after AMI, which may cause a silent and severe ischemic event a few days before the onset of PMR. This is a rare case of PMR immediately after AMI.>.
Keywords: Acute myocardial infarction; Mitral valve replacement; Papillary muscle rupture.