1. AM Report TJ O’Neill 3/24/10

6. 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

7. 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

8. 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

9. 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

10. Chordal Rupture Diagnosis Flail mitral leaflet

11. Chordal Rupture Diagnosis  Because regurgitant jet is asymmetric, pulmonary edema can occur unilaterally NEJM 361:e6. July 30 th 2009, 5.

12. 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

13. References  Br Heart J. 1983 October; 50(4): 312–317  Gabbay U, Yosefy C.,Int J Cardiol. 2010 Mar 6.  Heart 2009 Jun; 95 (12): 976-9.

14. For Inquiries Regarding the Train Shaped Cupcake Pan, Speak to Jason Haag