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A rare complication of AMI is papillary muscle rupture (PMR), occurring in 1% of patients with acute myocardial infarction (AMI). Mitral regurgitation related to PMR occurs at a median of 1 day (ranging from 1-14 days) after onset of myocardial infarction. PMR tends to occur in those having a first time AMI and those without extensive collateral circulation. PMR involves posteromedial papillary muscle and anterolateral papillary muscle in 75% and 25% of the cases, respectively. We report a 79-year-old man who referred to our hospital with acute severe pulmonary edema. Transthoracic echocardiography showed ruptured anterolateral head of papillary muscle resulting in flail anterior mitral valve leaflet and acute severe MR. Patient undergone emergent coronary angiography and we found normal epicardial coronary anteries. The patient was emergently transferred to operating room and MV was replaced with a bioprosthetic valve. He was discharged after one week, feeling well. This study proves the significant role of accurate transthoracic echocardiography in determining the mechanism of acute MR and planning for prompt treatment.

Keywords: Anterolateral papillary muscle, acute myocardial infarction, epicardial coronary arteries

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