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Papillary muscle rupture in acute myocardial infarction: Limitations of hand-held echocardiography

Thomas Kjeld, Peter Riis Hansen

Am J Case Rep 2008; 9:208-210

ID: 851970

Background: Hand-held echocardiographic systems have been shown to provide valid findings in the immediate diagnosis of cardiac abnormalities at the point of care. Some of these devices, however, have diagnostic limitations and may therefore be inadequate in the acute setting.
Case Report: We present a case of an inferior STEMI in normotensive pulmonary edema. Transthoracic echocardiography was performed with a hand held device (OptiGo, Vicare Medical) by a senior resident with level 3 training in echocardiography. The examination showed a preserved left ventricle ejection fraction and no apparent valve abnormality. Transesophageal echocardiography with another device disclosed severe mitral regurgitation due papillary muscle rupture. This was confirmed during acute open heart surgery. The patient recovered completely after surgery. Papillary muscle rupture causes acute mitral regurgitation and this complication of acute myocardial infarction has a high mortality. The survival rate is time dependent, hence prompt diagnosis and surgery most not be postponed.
Hand-held echocardiographic devices can be suitable for elective cardiac evaluation in the outpatient cardiology clinic, but these platforms may have significant technical limitations and a narrower diagnostic potential than full-featured standard echocardiography.
Conclusions: In conclusion thus we found that the hand-held device was unsuitable in the reported setting.

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