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CHORDAE TENDINeAE RUPTURE

AM Report TJ O’Neill 3/24/10. CHORDAE TENDINeAE RUPTURE. 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.

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CHORDAE TENDINeAE RUPTURE

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  1. AM Report TJ O’Neill 3/24/10 CHORDAE TENDINeAE RUPTURE

  2. 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

  3. 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

  4. 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

  5. Chordal RuptureDiagnosis • 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

  6. Chordal RuptureDiagnosis Flail mitral leaflet

  7. Chordal RuptureDiagnosis • Because regurgitant jet is asymmetric, pulmonary edema can occur unilaterally NEJM 361:e6. July 30th 2009, 5.

  8. Acute Mitral RegurgitationTreatment • 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

  9. 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.

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

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