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WHEN
THE HEART
IS
AT MECHANICAL FAULT
Apical
systolic murmurs of mitral
regurgitation (back
flow
of
the
blood
through
the
mitral
valve
in
the
left ven-
tricle of
the
heart) appear in more than
half
of
the
patients during the
first
5
days after
the
onset of
a
myocardial
infarction,
but
only
in
a
minority
of
pa-
tients
is
the mitral regurgitation of
he-
modynamic importance. ln one-third
of
patients
the
murmurs
are
present dur-
ing
the acute
phase
and
disappears
with
recovery.
The mostcommon cause
of mitral regurgitation following myocar-
dial infarction
is
dysfunclion
of
the pap-
illary muscles
in
the
left
ventricle,
due
to
ischemia or infarction.
Other pathologic
mechanisms
may contribute to
or
be
solely
respon-
sible for the development of mitral
re-
gurgitation after myocardial
infarction.
Mitral valve
competence
is
dependent
on
the
normal
spatial
relationships be-
tween
the
papillary muscles and the
mitral
valve; therfore, mitral
regurgita-
tion
may
be
the result of alteration
in
the size
or
shape
of
the ventricle due
to
impaired contractility or
to
aneurysm
formation.
Surgical replacement
ol
the
mitral
valve,
if
drug treatment (such as
captopril)
is
ineffective, may
be
followed
by
dramatic results in patients
in
whom
heart
failure results primarily from mitral
regurgitation due
to
papillary muscle
rupture or dysfunction and
in whom
myocardial function
is
maintained rela-
tively well.
2+
