This series of patients was treated before the widespread clinical availability of Doppler echocardiography, and hence this tool was unavailable for assessment of mitral regurgitation. Nevertheless, the definitive method of diagnosing a potentially reversible mechanical defect of the left ventricle is cardiac catheterization with left ventriculography. However, given the increased risk of ventriculography in patients […]

Discussion Although unusual, severe silent mitral regurgitation has been observed in several clinical settings: mitral stenosis, endocarditis, congestive cardiomyopathy, AMI, and, as shown here, with combined valvular and myocardial disease. Mitral regurgitation in the setting of AMI is probably underdiagnosed; a prevalence as high as or exceeding 50 percent has been documented. The soft or […]

Case 9 This 62-year-old woman was admitted to the New York Hospital in 1984 with severe dyspnea. There was a history of rheumatic fever, and in 1970 a Starr-Edwards aortic valve prosthesis was inserted at another hospital for severe aortic stenosis. Although the patient had relief of dyspnea, one year later she was readmitted with […]

Case 8 This 74-year-old woman was admitted with syncope and ventricular fibrillation. In the emergency room, electrical countershock restored sinus rhythm. The postconversion ECC revealed sinus tachycardia at 120 beats/min, a new right bundle branch block and ST segment elevation in the anterolateral leads. Past history was notable for a successful aortic valve replacement eight […]

Case 7 This 62-year-old woman was admitted with the sudden onset of pulmonary edema and respiratory failure. A Starr-Edwards aortic valve prosthesis had been implanted 19 years earlier for severe aortic regurgitation of rheumatic etiology. Three years before admission, mild exercise intolerance was noted. Serial M-mode echocardiography done 15 months before admission revealed normal left […]

Case 5 A 62-year-old woman was transferred to the New York Hospital because of hypotension. The patient had a history of systemic hypertension and diabetes mellitus, and had recently sustained a myocardial infarction with recurrent acute pulmonary edema. The patient was admitted to another hospital with dyspnea and rapid atrial fibrillation. Physical examination results there […]

Case 3 This 55-year-old woman was admitted with an AMI. Physical examination results revealed normal vital signs. The lungs were clear. An S4 gallop and a soft grade 2/6 systolic murmur were heard at the apex. The patients course was complicated by two episodes of paroxysmal supraventricular tachycardia and one episode each of severe hypotension […]