PMC9273235_01
A. Twelve-lead electrocardiogram; B. Angiographic image. Right anterior oblique caudal view of the left coronary artery. Arrow indicates site of vessel occlusion; C. Transoesophageal echocardiogram. Three-chamber view during systole; arrow indicates ruptured papillary muscle fragment prolapsed in the left atrium.
cardj-29-4-680f1.jpg
PMC9273235_01_cardj-29-4-680f1.jpg
f1-cardj-29-4-680
The electrocardiogram upon admission revealed sinus tachycardia (120 bpm) with a 3 mm ST depression in leads II, III, aVF, from V3 to V6, and ST elevation in leads I and aVR (Fig. 1A). Since the clinical scenario suggested acute non-ST-segment elevation myocardial infarction (NSTEMI) complicated by papillary muscle dysfunction, the patient underwent emergency cardiac angiography, which showed small intermediate and marginal branch occlusion; percutaneous coronary intervention (PCI) was not feasible due to their small sizes (Fig. 1B). In order to better evaluate the MR mechanism, transoesophageal echocardiogram was performed, detecting severe acute MR with anterolateral papillary muscle rupture (PMR) (Fig. 1C).