Elsevier

American Heart Journal

Volume 75, Issue 3, March 1968, Pages 399-415
American Heart Journal

The syndrome of papillary muscle dysfunction

https://doi.org/10.1016/0002-8703(68)90097-5Get rights and content

Abstract

The function of the papillary muscles to restrain the mitral valves is obvious. However, the dynamic nature of this function is not always appreciated. Failure of one or both papillary muscles to shorten during the ejection phase of ventricular systole, fibrosis, and atrophy of a papillary muscle or centrifugal migration of the papillary muscles due to left ventricular dilatation result in mitral incompetence. Depending upon the etiology of the papillary muscle dysfunction, apical systolic murmurs of varying characteristics may be heard. In general, a noncontracting papillary muscle in a normal-sized heart is associated with a murmur which is late in onset and crescendo-decrescendo in quality, whereas in the dilated heart the murmur is early, beginning with the first heart sound, and may be decrescendo, plateau, or crescendo-decrescendo in quality. Obviously, the murmurs of papillary muscle dysfunction may vary considerably depending upon the nature of the dysfunction and time course of activation of the muscle and other portions of the ventricular musculature. Associated electrocardiographic abnormalities may also occur.

Mitral insufficiency due to acquired or congenital valvular disease has been exhaustively studied. On the other hand, mitral insufficiency secondary to disease of the papillary muscles has been almost completely neglected. Nevertheless, since our description of the papillary muscle syndrome in 1963,1 more than 20 papers dealing directly or indirectly with this syndrome have appeared. In the present review we have extended the original description of the papillary muscle syndrome to include a number of diseases which either clinically or at necropsy have been implicated in the production of papillary muscle dysfunction in the hope that attention will be focused on those diseases, in addition to circulatory insufficiency, which may result in papillary muscle dysfunction.

References (51)

  • A. Leatham

    Auscultation of the heart

    Lancet

    (1958)
  • J.H. Phillips et al.

    Selected clues in cardiac auscultation

    Am. Heart J.

    (1962)
  • G.E. Burch et al.

    Murmurs of aortic stenosis and mitral insufficiency masquerading as one another

    Am. Heart J.

    (1963)
  • R.P. Henke et al.

    An aid to identification of the murmur of aortic stenosis with atypical localization

    Am. Heart J.

    (1960)
  • L. Vogelpoel et al.

    The use of amyl nitrate in the diagnosis of systolic murmurs

    Lancet

    (1959)
  • J.B. Barlow et al.

    Aneurysmal protrusion of the posterior leaflet of the mitral valve. An auscultatory-electrocardiographic syndrome

    Am. Heart J.

    (1966)
  • J.B. Barlow

    Conjoint clinic on the clinical significance of late systolic murmurs and nonejection systolic clicks

    J. Chronic Dis.

    (1965)
  • J.O. Humphries et al.

    The differentiation of organic and “innocent” systolic murmurs

    Progr. Cardiovas. Dis.

    (1962)
  • J.B. Barlow et al.

    The significance of late systolic murmurs

    Am. Heart J.

    (1963)
  • B.L. Segal et al.

    Late systolic murmur of mitral regurgitation

    Am. Heart J.

    (1964)
  • B. Segal et al.

    Mitral regurgitation in a patient with the Marfan syndrome

    Dis. Chest

    (1962)
  • R.J. Sanders et al.

    Perforation of interventricular septum complicating myocardial infarction

    Am. Heart J.

    (1956)
  • G.E. Burch et al.

    Clinical manifestations of papillary muscle dysfunction

    Arch. Int. Med.

    (1963)
  • J.H. Phillips et al.

    The syndrome of papillary muscle dysfunction. Its clinical recognition

    Ann. Int. Med.

    (1963)
  • R.C. Brock

    The surgical and pathological anatomy of the mitral valve

    Brit. Heart J.

    (1952)
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    Supported by grants from the United States Public Health Service, the Rudolph Matas Memorial Fund for the Kate Prewitt Hess Laboratory, and the Rowell A. Billups Fund for Research in Heart Disease.

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