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Clinical features of papillary muscle dysfunction

Conditions where you get murmur of Papillary muscle dysfunction 
  • Ischemia
  • Dilatation of left ventricle
  • Rupture of papillary muscle
  • Fibrosis of papillary muscle
What are the signs of papillary muscle dysfunction ?
  • Left ventricular S4
  • Late systolic or pansystolic murmur with late systolic accentuation
  • What are the murmurs in papillary muscle dysfunction ?
  • Late systolic murmur
  • Holosystolic with late systolic accentuation (severe LV dusfunction)
  • Holosystolic murmur
  • Decrescendo murmur
What are the characteristic of murmur in papillay muscle dysfunction ?
It is a late systolic murmur, or PSM with late systolic accentuation
Soft murmur of 2/6 intensity
There is poor correlation between intensity and severity of murmur.
Variabilities are present in intensity, configuration of frequency.
What is the basis of murmur in papillary muscle dysfunction ? 
Papillary muscle function is especially needed in the later part of systolic. So the murmur is PSM  with late systolic accentuation.
What is the basis of decrescendo murmur in papillary muscle dysfunction ?
Decrescendo nature of murmur is due to decreased size of left ventricular toward the end of systolic which help in better co-aptation and less reflux. 
What is the significance of S4 in MR due to papillary muscle dysfunction?
Absence of S4 with a late systolic murmur rules out the papillary muscle dysfunction.