An 80-year-old man with a past history of hypertension presented to an Emergency Department with chest pain for 2 h. His blood pressure was 80/60 mm Hg, heart rate was 124 beats/min, respiratory rate was 24 breaths/min, and oxygen saturation was 80% on a non-rebreather face mask. There was no jugular venous distension. The cardiac examination was pertinent for tachycardia and normal S1 and S2 heart sounds, without an audible murmur. Lungs had rales bilaterally. The remainder of the examination was unremarkable. An electrocardiogram showed sinus tachycardia with 3-mm ST-segment elevations in leads II, III, and aVF. He was transferred to our institution for primary percutaneous intervention. A transthoracic echocardiogram showed inferolateral wall akinesis, a normal left ventricular ejection fraction of 60%, and a ruptured posteromedial papillary muscle (Figure 1A ) with wide-open mitral regurgitation (Figure 1B). Coronary angiography showed occlusion of the distal left circumflex artery, with mild changes in the remaining coronary arteries. The patient was intubated for respiratory distress, an intra-aortic balloon pump was inserted, and he was referred to the operating room for emergency mitral valve surgery. An intra-operative transesophageal echocardiogram confirmed a ruptured posteromedial papillary muscle (Figure 2). He underwent a mitral valve replacement with a 27-mm St. Jude Medical Epic tissue valve (St. Jude Medical Inc., St. Paul, MN), and was discharged in good health on hospital day 9.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Emergency Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
Published online: February 08, 2011
Accepted: November 5, 2010
Received in revised form: July 3, 2010
Received: February 12, 2010
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.