Atypical acute myocardial infarction presenting as papillary muscle rupture and pulmonary edema: A case report

Objective: We present a rare and diagnostically challenging case of rupture of the posteromedial papillary muscle caused by chronic ischemia of the circumflex artery.The uniqueness of this case lies in the absence of typical symptoms of acute myocardial infarction (AMI), including chest pain, as well as atypical electrocardio graphic findings that do not indicate AMI.Case presentation: A 70-year-old female with hypertension presented with progressive dyspnea but no chest pain or AMI signs on electrocardiogram.Initial heart failure treatment yielded no improvement, prompting echocardiography, which revealed prolapse of the posterior mitral leaflet and free movement of the posteromedial papillary muscle, resulting in acute mitral regurgitation.Coronary angiography confirmed multivessel coronary artery disease, with significant stenosis in the circumflex artery.The patient underwent mitral valve replacement with coronary artery bypass grafting.Conclusion: This case highlights the potential for atypical presentations of papillary muscle rupture in chronic ischemic conditions and underscores the importance of echocardiography in cases with ambiguous clinical findings.