Mechanical complications of MI. VSD

Q. Why VSD is very rare.

Because if dual supply of septum. Anterior two thirds by ant.descending artery and post 1/3rd by Rca or Lcx.

Q. When it occurs.

In reperfused, within 2 days. In unperfused peaks on day 1 and then with in a week.

Mechanical complications of MI. MR

 Q. Percentage of MR after MI.

20%. Both in AW &IW MIs. Most commonly mild - mod. 

Q. Which MI commonly causes Tethering or decreased mobility 

IWMI

Q. Which leaflet is commonly involved in tethering and why.

Posteriot leaflet because of its shorter length and higher area of attachment

Q. Downward and lateral displacemnt of papillary muscles seen in which MI

AWMI

Q. What are the prognostic factors to look for in post CABG patients with moderate MR.

1. Number of segments of viable myocardium

2. Dyssynchrony in ecg.

Q.What is the mortality benefit for patients undergoing CABG with mitral valve repair

NO significant mortality benefit (89+/- 3 vs 94+/-  3) but symptomatic and 2d dimentional improvement can be seen

Q. Tenting and tethering of PML is seen in which MI.

IWMI

Q. What is the reason for MR in ischemic cardiomyopthy

Mitral annular flattening and dilatation.

Q. Why postero medial papillary muscle is very common to get ruptured ?

It has single blood supply from posterior descending artery where as antero lateral papillary muscle has dual blood supply from diagonal branch of LAD and LCX. HENCE 6to 12 times more common

Q. Why early diagnosis of papillary muscle rupture is important 

Rupture occurs in 2 to 7 days of ILMI. Any post MI with SOB and new murmur can be suspected. 50% mortality within a day and 90% if untreated by surgery in a weak.

 Q. What are the echo findings in rupture of papillary muscle

Marked buckling of mitral leaflet into LA and ruptured papillary muscle base in LV.If it is not visualized any eccentric jet with normal LA size must be the clue. 

Q. In a case of pulmonary edema and a normal mitral colour doppler what are the signs of papillary muscle rupture

Small infarction, hyperdynamic LV , increased early mitral inflow velocity. Careful search for MR is must in such conditions

PFO TUNNEL