Structural Causes
Also written as PALM.
(The non-structural causes are COEIN: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic and not yet classified.)
What our notes say
- (The non-structural causes are COEIN: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic and not yet classified.) (Year 6 Gynaecology CAT 1 (MBOG 6511): 13 December 2019, 4 short answers and 16 M)
Study material on Structural Causes
Practice questions on Structural Causes
63-year-old, known CAD, new harsh pansystolic murmur + cardiogenic shock 4 days after large inferior MI, severe MR on echo. MOST likely structural cause?
- Left ventricular free wall rupture with pseudoaneurysm
- Aortic root dilation causing aortic regurgitation
- Rupture of the interventricular septum creating an acquired VSD
- Dressler syndrome causing pericardial effusion
- Papillary muscle rupture causing acute mitral valve incompetence
Answer: E. - Inferior MIs (RCA territory) put the **posteromedial papillary muscle** (single blood supply) at high risk of rupture, causing acute severe MR — typically 3–7 days post-MI ---
A 63-year-old male with known coronary artery disease develops a new harsh pansystolic murmur and signs of cardiogenic shock 4 days after a large inferior MI. Echocardiography shows severe mitral regurgitation. What is the MOST likely structural cause?
- A rupture of the interventricular septum creating an acquired VSD
- Papillary muscle rupture causing acute mitral valve incompetence
- Dressler syndrome causing pericardial effusion
- Left ventricular free wall rupture with pseudoaneurysm
- Aortic root dilation causing aortic regurgitation ✅ Answer: B
Answer: A. Papillary muscle rupture is a known mechanical complication of MI, typically occurring 3-7 days post-MI, leading to acute severe mitral regurgitation and cardiogenic shock.