Severe “Silent” Mitral Regurgitation

Schreiber, Theodore; Fisher, John F.; Mangla, Arun; Miller, D. H.

doi:10.1378/chest.96.2.242

Cited by 11 publications

(2 citation statements)

References 25 publications

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“…One of the key diagnostic findings in this case was the presence of unilateral pulmonary edema (UPE) on the initial chest radiograph and POCUS. In a recent large, retrospective European study of patients referred to the intensive or coronary care units with cardiogenic shock, UPE was invariably associated with severe MR. 9 Although the finding of right-sided UPE was much more common, prolapse of the anterior leaflet, as was the case with our patient, was associated with left-side UPE.…”

Section: Discussionsupporting

confidence: 62%

Repeat Point-of-Care Echocardiographic Evaluation of Traumatic Cardiac Arrest: A New Paradigm for the Emergency Physician

Thomas

Durant

Barbant

et al. 2017

CPCEM

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We report a case of a 52-year-old man who presented to the emergency department (ED) in extremis (hypotensive with an altered sensorium) with subsequent cardiac arrest after a motor vehicle collision. The initial trauma evaluation did not reveal a source of the hemodynamic compromise. A point-of-care ultrasound revealed severe mitral regurgitation secondary to an anterolateral papillary muscle rupture. Patient underwent successful emergent mitral valve replacement after initial resuscitative efforts and intraaortic balloon pump placement.

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Section: Discussionsupporting

confidence: 62%

Repeat Point-of-Care Echocardiographic Evaluation of Traumatic Cardiac Arrest: A New Paradigm for the Emergency Physician

Thomas

Durant

Barbant

et al. 2017

CPCEM

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“…In the context of PMR with “wide open” MR, the absence of a murmur may belie equalization of pressures between the left atrium and left ventricle, with decreased regurgitant volume through the valve in the setting of cardiogenic shock. This has been termed “silent MR” ( 5 , 6 ) and highlights the importance of maintaining a high index of suspicion and understanding various physiologic presentations of PMR.…”

Section: Question 4: Which Physical Examination Findings Would Be Expected In Pmr and How Might These Findings Be Explained By Underlyingmentioning

confidence: 99%

Papillary Muscle Rupture Complicating Acute Myocardial Infarction

et al. 2020

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Papillarmuskelriß während eines Belastungs-EKGs nach Myokardinfarkt

Hanke

Raschka

Strupp

et al. 1999

Zeitschrift f�r Kardiologie

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The case of a 57 year old patient is reported, who suffered from an acute myocardial infarction with maximum CK and CKMB values of 821 and 84 U/l, respectively. The patient underwent bicycle exercise testing 9 days after a myocardial infarction in 25 W steps every 2 min starting with 50 W. The ergometry was interrupted at 125 W because of ST segment depression of 0.28 mV in V6. Systolic blood pressure dropped to 55 mm Hg, combined with severe angina and shock. Volume substitution and catecholamines did not elevate blood pressure. Immediate M-mode and Doppler echo revealed a "stiletto"-shaped mitral regurgitation profile typical of acute mitral valve insufficiency. The transesophageal echocardiogram showed a distinct mass moving between the left ventricle and left atrium, diagnostic of papillary muscle rupture. Despite of shock, mitral valve replacement was performed successfully. To our knowledge, this is the first report of a papillary muscle rupture during exercise testing after myocardial infarction. Papillary muscle rupture can be induced by exercise. This fateful event may not be predicted by the course of the ergometry. In case of hypotension during exercise, papillary muscle rupture should be considered. The diagnosis is to be established by transesophageal echocardiography.

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Severe “Silent” Mitral Regurgitation

Cited by 11 publications

References 25 publications

Repeat Point-of-Care Echocardiographic Evaluation of Traumatic Cardiac Arrest: A New Paradigm for the Emergency Physician

Repeat Point-of-Care Echocardiographic Evaluation of Traumatic Cardiac Arrest: A New Paradigm for the Emergency Physician

Papillary Muscle Rupture Complicating Acute Myocardial Infarction

Papillarmuskelriß während eines Belastungs-EKGs nach Myokardinfarkt

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