AM Report TJ O’Neill 3/24/10
Cardiogenic Shock w/ Preserved EF With pulmonary edema Acute severe aortic regurgitation Acute severe mitral regurgitation Without pulmonary edema Cardiac Tamponade Acute massive PE Acute RV infarction
Chordae Rupture First described in 1806 Most commonly “primary”, highest association w/ rheumatic fever, infectious endocarditis Also MVP, collagen vasc disease, trauma, hypertrophic, but also longstanding hypertension Chordae classified based on site of insertion
Chordae Rupture 6.6–8.1% of all valvular surgeries, 9.3–20% of all mitral valve surgeries 26% among emergency mitral regurgitation surgeries P2, P3, or P 2-3 are most likely to flail
Chordal Rupture Diagnosis Rapid clinical deterioration is frequent w/ associated dyspnea, tachypnea, pulmonary edema Chordal rupture will usually have associated gallop S3 and S4 w/ hyperactive prechordium and possible thrill Murmur may radiate upward, posterior as well as apical and compared to chronic MR is early to mid- peaking due to lack of a compliant atrium
Chordal Rupture Diagnosis Flail mitral leaflet
Chordal Rupture Diagnosis Because regurgitant jet is asymmetric, pulmonary edema can occur unilaterally NEJM 361:e6. July 30 th 2009, 5.
Acute Mitral Regurgitation Treatment Afterload reduction if BP tolerates ACE-I, Hydralazine, Sodium nitroprusside Diuretics Intra-aortic balloon pump CT surgery consult for any symptomatic patients as mortality is much higher than chronic MR
References Br Heart J October; 50(4): 312–317 Gabbay U, Yosefy C.,Int J Cardiol Mar 6. Heart 2009 Jun; 95 (12):
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