Myocardial ischemia: Acute MR


Caused by papillary rupture, acute MR can present itself with the following symptoms and signs.

Symptoms/Signs: acute CHF, hypotension, increased pulmonary congestion. Increased Left atrium pressures because no time for left atrial compensatory mechanisms to occur and a V wave seen on the LAP, PAP, or PCWP tracing. On echocardiography, the LV and LA size will be normal (since it just occurred), yet the MR jet V wave will be increased.

Treatment: in the patient with acute severe MR and cardiogenic shock from ischemic rupture of a papillary muscle, pharmacologic support of the left ventricle, often accompanied by mechanical support with IABP counterpulsation, may be necessary.


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