A series comprising 36 cases with infarction of the papillary musle of the heart is reviewed (26 are studied pathologo-anatomically and clinically and 10 - clinically). It is established that infarction of the papillary muscles is encountered in 34.66 per cent of all patients with infarction of the myocardium. The mean age of the patients is 64,7 years, with a 2.7: 1.3 male to female ratio. Insofar etiology is concerned, the following conditions appear to be of importance: coronary sclerosis, hypertonic disease, diabetes mellitus, lues and rheumatism. The clinical picture is not typical, with frequent occurrence of circulatory collapse and pulmonary edema. The auscultatory-electrophonocardiographic alterations are manifested by dull cardiac tones, weakened initial tone, rhomboid systolic sound at the cardiac apex and characteristic changes in JV4_6 and ST—TV4-6. The latter finding is disclosed in five distinct varieties. In instances of infarction of the postero-medial papillary muscle QV5_e is absent, whereas in infarction of the antero-lateral muscle it is present. Characteristic changes in the direction of the space vectors of QRS, T, J and P are likewise noted. Differential diagnosis in the latter infarction type is discussed and attention is drawn to its distinction from left ventricular hypertrophy. The poor prognosis is stressed in the instances of infarction of the myocardium, complicated by infarction of papillary muscles.
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