Triphasic mitral inflow in acute coronary syndrome: A case study
Ikuo Misumi1, Kenji Ebihara1, Ryuichiro Akahoshi1
1Department of Cardiology, Kumamoto Saisyunsou Hospital, 2659 Suya, Koushi 861-1196, Japan.
Journal of Cardiology Cases
|December 12, 2018
Summary
A triphasic mitral inflow pattern, typically seen in diastolic heart failure, was observed in a patient with acute coronary syndrome (ACS). This finding highlights a potential indicator of low left ventricular distensibility during acute cardiac events.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Internal Medicine
Background:
- Acute coronary syndrome (ACS) can present with diverse echocardiographic findings.
- Diastolic dysfunction is a common complication of ACS.
- Triphasic mitral inflow patterns are traditionally associated with hypertrophic diastolic heart failure.
Purpose of the Study:
- To report a case of triphasic mitral inflow pattern in a patient with acute coronary syndrome.
- To explore the underlying pathophysiology of this pattern in the context of ACS.
- To expand the understanding of mitral inflow patterns in cardiac emergencies.
Main Methods:
- Case report of an 86-year-old female presenting with acute chest pain.
- Utilized electrocardiogram, chest roentgenogram, echocardiogram, and cardiac catheterization.
- Assessed mitral inflow patterns with pulsed Doppler echocardiography, including response to preload augmentation via leg elevation.
Main Results:
- Echocardiography revealed left ventricular (LV) hypokinesis and abnormal mitral inflow.
- Leg elevation induced an intermittent triphasic mitral inflow pattern and elevated LV diastolic pressure with a "dip-up-down" pattern.
- Cardiac catheterization confirmed acute coronary syndrome, leading to percutaneous coronary intervention.
Conclusions:
- A triphasic mitral inflow pattern can occur in acute coronary syndrome, not solely in hypertrophic diastolic heart failure.
- This pattern may indicate low LV distensibility and markedly increased preload.
- This case is the first to describe and elucidate the pathophysiology of triphasic mitral inflow in ACS.
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