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Sudden, severe mitral insufficiency
Abstract:
Five male patients with sudden, severe mitral insufficiency due solely to ruptured chordae tendineae or papillary muscle had an abrupt onset of symptoms of left and right heart failure and the sudden appearance of a harsh, widely propagated apical pansystolic murmur. None had a history of rheumatic fever. All were in sinus rhythm and had but mild left atrial and ventricular enlargement. Giant left atrial "v" waves were characteristic and exceeded pulmonary artery pressure in two instances.In contrast, when ruptured chordae tendineae were superimposed on chronic rheumatic mitral insufficiency, females predominated and there was a long history of disability. Atrial fibrillation, less elevation of left atrial pressure, and marked left atrial and ventricular enlargement were characteristic. These latter patients closely resembled patients with chronic rheumatic mitral insufficiency alone.It is concluded that the syndrome of sudden, severe mitral insufficiency develops if ruptured chordae tendineae occur on a previously normal or insignificantly diseased mitral valve. If ruptured chordae tendineae are superimposed on chronic rheumatic mitral insufficiency, the syndrome resembles that seen in the latter alone.
Insights
Sudden mitral insufficiency occurs when ruptured chordae tendineae affect a healthy mitral valve, causing acute heart failure. When superimposed on rheumatic heart disease, symptoms are less abrupt and resemble chronic mitral insufficiency.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pathophysiology
Background:
- Ruptured chordae tendineae can cause acute or chronic mitral insufficiency.
- Distinguishing between acute and chronic presentations is crucial for patient management.
Purpose of the Study:
- To differentiate the clinical presentation and echocardiographic findings of acute mitral insufficiency due to ruptured chordae tendineae on a normal valve versus superimposed on chronic rheumatic mitral insufficiency.
Main Methods:
- Case series analysis of five male patients with acute mitral insufficiency from ruptured chordae tendineae.
- Comparison with a cohort of patients with rheumatic mitral insufficiency.
Main Results:
- Acute cases presented with sudden heart failure symptoms, a harsh pansystolic murmur, and giant 'v' waves in the left atrium.
- Chronic cases (superimposed on rheumatic disease) showed female predominance, atrial fibrillation, and marked chamber enlargement.
Conclusions:
- Sudden, severe mitral insufficiency results from ruptured chordae tendineae on a previously normal mitral valve.
- When ruptured chordae tendineae occur in the context of chronic rheumatic mitral insufficiency, the clinical picture resembles the underlying rheumatic condition.