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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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cardiogenic shock w preserved ef
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
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 rupture1
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
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
chordal rupture diagnosis1
Chordal RuptureDiagnosis

Flail mitral leaflet

chordal rupture diagnosis2
Chordal RuptureDiagnosis
  • Because regurgitant jet is asymmetric, pulmonary edema can occur unilaterally

NEJM 361:e6. July 30th 2009, 5.

acute mitral regurgitation treatment
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
references
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.