The murmur of papillary muscle dysfunction in acute myocardial infarction: clinical features and prognostic implications

American Heart Journal
A S MaiselD Collins

Abstract

The systolic murmur of papillary muscle dysfunction is a well-recognized feature of acute myocardial infarction (AMI), but no large prospective studies have determined its incidence, associated variables, and prognostic implications. Of 1653 patients who entered our data base with MI, 283 (17%) were classified as having a systolic murmur suggesting mitral regurgitation. At hospital discharge, there was a 5% incidence. There was a higher incidence of systolic murmur in non-Q wave AMI than in inferior or anterior Q wave MI (24% vs 13% and 15%, p less than 0.001). Advanced age, previous MI, and heart failure were all associated with systolic murmur (p less than 0.01). Persistent pain in the coronary care unit occurred more often in those with systolic murmur (45% vs 26%, p less than 0.0001). Systolic murmur was associated with an S3 and bibasilar rales (p less than 0.001) in the hospital; however, it was inversely related to peak creatine kinase and unrelated to heart failure or ejection fraction at discharge. Univariate predictors of mortality associated with systolic murmur included complex premature ventricular contractions at discharge and a non-Q wave location. Patients with systolic murmur had higher hospital and 1-year mort...Continue Reading

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Citations

Sep 17, 2010·Srpski arhiv za celokupno lekarstvo·Mile VrenesAleksandar Djordjević
Jun 1, 1995·The American Journal of Medicine·B E Marx, A R Feinstein
Feb 1, 1989·American Heart Journal·T L SchreiberB Zola
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Jun 17, 2008·The American Journal of the Medical Sciences·Kasper IversenHenrik Nielsen
Nov 19, 2002·Coronary Artery Disease·Yochai BirnbaumBarry F Uretsky

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