A 68-year-old man with an acute inferior STEMI develops sudden severe pulmonary edema and a new holosystolic murmur at the apex radiating to the axilla on day 3. Echocardiography shows a flail mitral leaflet with severe mitral regurgitation. What is the definitive management?

• A Emergency PCI of the infarct-related artery
• B Fibrinolytic therapy
• C Intra-aortic balloon pump and medical management
• D Mitral valve surgery (repair or replacement) ✓

Explanation

Papillary muscle rupture is a mechanical complication of acute MI causing acute severe mitral regurgitation. It typically occurs 2-7 days post-inferior STEMI (posterior papillary muscle, single blood supply). Definitive treatment is urgent mitral valve surgery. IABP is a bridge to surgery. PCI of the infarct-related artery does not correct the mechanical defect. Fibrinolysis is contraindicated in this setting.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.