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Papillary muscle atrophy — Clinical Guidelines

Overview

Papillary muscle atrophy refers to the reduction in size and function of the papillary muscles, often associated with myocardial remodeling in conditions like ischemic heart disease or dilated cardiomyopathy. This condition can lead to impaired valve function and heart failure symptoms.

Diagnosis

Echocardiography: Essential for assessing papillary muscle size and function 6.

Cardiac MRI: Provides detailed imaging to evaluate muscle atrophy and myocardial tissue characteristics 6.

Clinical Correlation: Often diagnosed in conjunction with signs of heart failure or valvular dysfunction 6.

Management

Optimization of Heart Failure Therapy: Use of ACE inhibitors/ARBs, beta-blockers, and diuretics to manage underlying heart failure 6.

Rehabilitation Programs: Physical therapy and exercise regimens to improve overall cardiac function, though specific protocols for papillary muscle atrophy are limited 2.

Nutritional Support: Ensuring adequate vitamin D levels to support muscle health, particularly in elderly patients 3.

Special Populations

Elderly: Higher risk due to age-related muscle atrophy and potential vitamin D deficiency impacting muscle trophicity 3.

Comorbidities: Management should consider coexisting conditions like diabetes or renal failure, which may affect treatment choices and outcomes 6.

Key Recommendations

Regular echocardiographic monitoring to assess papillary muscle changes and function (Evidence: Moderate 6).

Implement comprehensive heart failure management strategies including ACE inhibitors/ARBs and beta-blockers (Evidence: Strong 6).

Consider nutritional interventions, particularly vitamin D supplementation, in elderly patients to support muscle health (Evidence: Moderate 3).

Tailor rehabilitation programs cautiously, focusing on overall cardiac rehabilitation without specific evidence for papillary muscle atrophy (Evidence: Weak 2).

Closely monitor and manage comorbidities to optimize overall patient outcomes (Evidence: Moderate 6).

References

1 Umezawa H, Daimon K, Fujiwara H, Nishiwaki Y, Michikawa T, Okada E et al.. Changes in cross-sectional areas of posterior extensor muscles in thoracic spine: a 10-year longitudinal MRI study. Scientific reports 2022. link 2 Amirthalingam T, Mavros Y, Wilson GC, Clarke JL, Mitchell L, Hackett DA. Effects of a Modified German Volume Training Program on Muscular Hypertrophy and Strength. Journal of strength and conditioning research 2017. link 3 Domingues-Faria C, Boirie Y, Walrand S. Vitamin D and muscle trophicity. Current opinion in clinical nutrition and metabolic care 2017. link 4 Urushiyama T, Akutsu S, Miyazaki J, Fukui T, Diekwisch TG, Yamane A. Change from a hard to soft diet alters the expression of insulin-like growth factors, their receptors, and binding proteins in association with atrophy in adult mouse masseter muscle. Cell and tissue research 2004. link 5 Yoshikawa A, Mitsuhashi H, Sasagawa N, Tsukahara T, Hayashi Y, Nishino I et al.. Expression of ARPP-16/19 in rat denervated skeletal muscle. Journal of biochemistry 2003. link 6 Ingemann-Hansen T, Halkjaer-Kristensen J. Computerized tomographic determination of human thigh components. The effects of immobilization in plaster and subsequent physical training. Scandinavian journal of rehabilitation medicine 1980. link 7 MacDougall JD, Elder GC, Sale DG, Moroz JR, Sutton JR. Effects of strength training and immobilization on human muscle fibres. European journal of applied physiology and occupational physiology 1980. link

Papillary muscle atrophy