PAPILLARY-MUSCLE RUPTURE FOLLOWING MYOCARDIAL-INFARCTION - PIVOTAL ROLE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN PATIENTS WITH ATYPICAL PRESENTATIONS

Papillary muscle rupture is an uncommon, catastrophic complication of myocardial infarction that is potentially correctable if promptly diag nosed. Two cases are described in which the diagnosis of papillary mus cle rupture was complicated by unusual initial presentations, absence of audible murmurs, and technically difficult, nondiagnostic transthor acic ecdocardiograms. In both cases, a high index of clinical suspicio n for papillary muscle rupture led to transesophageal echocardiography and a rapid, definitive diagnosis. Since early surgery may be importa nt in this disorder, a rapid, reliable diagnosis is essential and tran sesophageal echocardiography is the diagnostic procedure of choice.