The Syndrome of Papillary Muscle Dysfunction
Authors: J. H. PHILLIPS
Journal: Annals of Internal Medicine (1963)

Article1 October 1963The Syndrome of Papillary Muscle DysfunctionIts Clinical RecognitionJ. H. PHILLIPS, M.D., G. E. BURCH, M.D., F.A.C.P., N. P. DE PASQUALE, M.D.J. H. PHILLIPS, M.D., G. E. BURCH, M.D., F.A.C.P., N. P. DE PASQUALE, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-59-4-508 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptRecently 2 patients have been reported with clinical manifestations of mitral valve insufficiency, in whom subsequent autopsy findings strongly suggested that papillary muscle dysfunction secondary to myocardial infarction was the underlying cause (1). Evidence was offered to support the contention that mechanical dysfunction of the papillary muscle may result in a murmur of mitral incompetence with characteristics distinctive enough to aid in its clinical recognition. The characteristicauscultatory finding is a systolic murmur, loudest at the apex, with delayed onset after the first heart sound and with a tendency to an "ejection" or "diamond-shaped" configuration (Figure 1). The most important...References1. BURCHDE PASQUALEPHILLIPS GENPJH: Clinical manifestations of papillary muscle dysfunction. Arch. Intern. Med. (Chicago) (To be published). Google Scholar2. PHILIPSDEPASQUALEBURCH JHNPGE: The electrocardiogram in infarction of the anterolateral papillary muscle. Amer. Heart J. (To be published). Google Scholar3. VOGELPAELSCHIRE LV: The use of amyl nitrite in the diagnosis of systolic murmurs. Lancet 2: 810, 1959. CrossrefMedlineGoogle Scholar4. PHILLIPSBURCH JHGE: Selected clues in cardiac auscultation. Amer. Heart J. 63: 1, 1962. CrossrefMedlineGoogle Scholar5. SHAPIROWEISS HADR: Mitral insufficiency due to ruptured chordae tendineae simulating aortic stenosis. New Eng. J. Med. 261: 272, 1959. CrossrefMedlineGoogle Scholar6. 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EDWARDSLEVY JEMJ: Anatomy of mitral insufficiency. Prog. Cardiov. Dis. 5: 119, 1962. CrossrefMedlineGoogle Scholar14. LEATHAM A: The value of auscultation in cardiology. Arch. Intern. Med. (Chicago) 105, 1960. CrossrefMedlineGoogle Scholar15. MCKUSICK VA: Symposium on cardiovascular sound. Circulation 16: 414, 1957. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: New Orleans, LouisianaFrom the Department of Medicine of the Tulane University School of Medicine, the Charity Hospital of Louisiana, and the Veterans Administration Hospital, in New Orleans.This work was supported by grants from the United States Public Health Service, Bethesda, Maryland.Requests for reprints should be addressed to G. E. Burch, M.D., Tulane University School of Medicine, New Orleans, Louisiana. 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ROBERTS, M.D., JOSEPH K. PERLOFF, M.D.Physical Signs, Apexcardiography, Phonocardiography, and Systolic Time Intervals in Angina PectorisSilent Mitral Regurgitation Complicating Silent Myocardial Infarction: Hemodynamic and Morphologic DocumentationLeft Ventricular Papillary MusclesForeign Body of the Heart Complicated by Papillary Muscle Necrosis Located by EchocardiographyLate Systolic Murmur in Coronary Artery DiseaseArrhythmias on exercise in patients with abnormalities of the posterior leaflet of the mitral valveMitral insufficiency following experimental papillary muscle infarctionProlonged bed rest in the treatment of idiopathic cardiomyopathyEtiology and electrocardiographic features of the billowing posterior mitral leaflet syndromeMidsystolic Clicks in Arteriosclerotic Heart DiseaseEtiology and differential diagnosis of acute mitral regurgitationCombined Papillary Muscle and Left Ventricular Wall Dysfunction as a Cause of Mitral RegurgitationLeft Ventricular Anatomical and Functional Abnormalities in Chronic Postinfarction Heart FailureWILLIAM A. BAXLEY, M.D., F.A.C.P., WILLIAM B. JONES, M.D., F.A.C.P., HAROLD T. DODGE, M.D., F.A.C.P.Abnormal regional myocardial performance in coronary artery diseaseIsolated congenital mitral insufficiency: Pathologic and surgical variations in five childrenSERIAL OBSERVATIONS ON LEFT VENTRICULAR DYSFUNCTION IN ACUTE MYOCARDIAL INFARCTIONMorphologie der MyokarditisIII. PodiumsgesprächThe value and limitations of necropsystudies in coronary arterial diseasePostexercise arrhythmias in the billowing posterior mitral leaflet syndromeIntermittent Severe Mitral RegurgitationMyxomatous transformation of the aortic and mitral valve with subaortic "sail-like" membraneElectrocardiography in Acute Papillary Muscle Dysfunction and Infarction: A Clinicopathologic StudyClinical pathologic conferencePathology of the failing heartPathology of the failing heartThe Clinical Spectrum of Papillary-Muscle DiseaseSome new observations on the syndrome of papillary muscle dysfunctionGeriatric cardiologySurgery for Complications of Myocardial InfarctionCurrent Views on Mitral Valve IncompetenceTHE AUTOPSY INCIDENCE OF FIBROSIS AND INFARCTION OF THE PAPILLARY MUSCLES OF THE LEFT VENTRICLESevere mitral insufficiency in early infancyA reappraisal of papillary muscle dysfunctionPapillary muscle fibrosis in primary myocardial diseaseA New Clinical Sign of Anomalous Coronary ArteryPapillary-Muscle Dysfunction in Myocardial InfarctionThe Murmurs of Mitral RegurgitationTransient systolic murmurs in angina pectorisExperimental papillary muscle infarctionCase 36-1968Surgically Correctable Cardiac Complications of Acute Myocardial InfarctionSignificance of Systolic Murmurs in the AgedAnomalous Origin of the Left Coronary Artery from the Pulmonary TrunkMuscular subaortic stenosisSOME ASPECTS OF MITRAL REGURGITATION IN MANHeart muscle diseaseZur HerzklappeninsuffizienzThe syndrome of papillary muscle dysfunctionThe coronary circulation and conduction system in acute myocardial infarctionLate systolic murmurs and non-ejection ("mid-late") systolic clicks. An analysis of 90 patients.Case 41-1967Postinfarction interventricular septal defectsThe late systolic murmurClinical signs of severe acute mitral regurgitation∗A diastolic murmur arising in a stenosed coronary arteryCongenital right coronary artery to left atrium fistula∗Mitral incompetence complicating acute myocardial infarction.Case 52-1966Mitral Insufficiency Secondary to Ruptured Chordae TendineaeRICHARD H. CHILDRESS, M.D., JOSEPH C. MAROON, M.D., PASQUALE D. GENOVESE, M.D., F.A.C.P.The late apical systolic murmurThe syndrome associated with midsystolic click and late systolic murmurInfarction of Papillary Muscles and Mitral Insufficiency Associated with Congenital Aortic StenosisAneurysmal protrusion of the posterior leaflet of the mitral valveFunctional mitral insufficiency in acute myocardial ischemiaRuptured papillary muscle after acute myocardial infarctionLate systolic murmurs and mitral regurgitationPathologische Anatomie des insuffizienten HerzklappenapparatesCase 55-1964The anomalous left coronary arteryCase 2-1964 1 October 1963Volume 59, Issue 4Page: 508-520KeywordsAutopsyElectrocardiographyHeartHospital medicineLesionsMedical servicesMitral insufficiencyMyocardial infarctionPapillary musclesSystolic ejection murmur Issue Published: 1 October 1963 PDF DownloadLoading ...