Question regarding coronary blood flow to left posterior

[Bromley]

Hi, I normally post on the heart rhythm forum, but came across a need to understand left posterior papillary muscle ischemia. Does any one here have some information, or know how to find out which coronary artieries feed the posterior papillary muscles, or how the return flow from the posterior papillaries works?  

Also, I recently visited the University of MN visual heart lab web site and noticed several videos that appear to show the inside of the heart as taken through an endoscope of some type.  Does anyone know whether this type of device is currently in routine use during cardiac procedures?

Thanks in advance for any information you have.

[ed34]

An angiogram would have revealed any blockages in the Left circumflex and PDA. As for string damage, this would likely cause a substantial regurgitation and could be clearly seen on an echo scan. One thing to consider is vasospasm which can be triggered by exercise. One of your arteries could be going into spasm and disrupting blood flow. There are medications for this, I was put onto meds for 3 months and they stopped. The type of med I was put onto was a calcium channel blocker and a mild dose. Diltiazem was the drug.

[Bromley]

Yep. That was suggested.  I am going to talk to a couple of people and then I assume they will run me through the ringer,  trying to get a 12 lead on that. I previously passed an angiogram,  which is one reason I wonder about which arteries are involved,  and what's covered on a standard angio. Vt is not the expected result of an ablation for wpw, so the question is why. The ablation catheter passed through the aortic valve into the left ventricle and would have been guided using fluoroscopy past or thru mitral valve strings to its intended target under the mitral annulus. These strings attach to the mitral valve and to the the papillary muscle. The papillary muscle may be the site of origin for the vt. If so,  I reason that three likely possibilities are 1. Damage to strings,  valve,  or papillary 2. Papillary ischemia caused by damage to blood flow 3. Idiopathic origin.  There are other possibles too, but The procedure for ablating the papillary is complex.  So I am trying to be a little analytical about this. If the cause is ischemia for instance,  not sure I would want to pursue ablation.  It would be nice if they could look in there and see what if anything may have happened.

Anyway,  thanks for your post.

[ed34]

Sounds like the first step would be a standard stress test where they can monitor your blood pressure and heart rhythm.

[Bromley]

Thank you for your post.  Following an ablation,  I have short episodes of nsvt, ecg seems left posterior type,  and since it tends to be exercise related,  I thought maybe I had some damage or ischemia on one of the left papillary muscles. One way that could happen would be if the ablation affected one of the arteries,  or damaged the papillary, mitral valve, or strings.

I had wondered which arteries were involved. And about the best way to look at the affected area on the inside of the heart.