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Papillary muscle rupture after myocardial infarction — ABIM Board MCQ

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HardCardiovascularPapillary muscle rupture after myocardial infarctionABIM Board

A 72-year-old man develops sudden pulmonary edema 5 days after an inferoposterior myocardial infarction. He is hypotensive with a new harsh systolic murmur at the apex radiating to the axilla. Echocardiography shows flail posterior mitral leaflet and severe acute mitral regurgitation. Which of the following is the most likely cause?

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Correct answer: C — Papillary muscle rupture after myocardial infarction

Acute severe MR with pulmonary edema and shock several days after inferior MI is classically due to papillary muscle rupture, particularly posteromedial papillary muscle rupture.

Reference: 2020 ACC/AHA Valvular Heart Disease Guideline; AHA ACS Guidance