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(Circulation. 2006;113:e852.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

A 54-Year-Old Woman With Chest Pain, Dyspnea, and Inferior Injury on Electrocardiography

Joseph M. Szczytowski, DO; Timothy A. Mixon, MD; Raul A. Santos, MD; Mark E. Lawrence, DO

From the Division of Cardiology, Scott and White Memorial Hospital, Temple, Tex.

Correspondence to Joseph Szczytowski, DO, Scott and White Memorial Hospital, Temple, TX 76508. E-mail jszczytowski{at}swmail.sw.org

A 54-year-old woman presented with acute dyspnea after having approximately 36 hours of stuttering chest and abdominal pain. On initial examination, she was noted to have severe pulmonary edema and a low-pitched holosystolic murmur at the apex. The ECG demonstrated an inferior injury pattern, and she was taken to the cardiac catheterization laboratory. Angiography revealed left-dominant anatomy with occlusion of the distal left circumflex artery. Results of the left ventriculogram are shown and demonstrate severemitral regurgitation with opacification of all 4 pulmonary veins (Figure). An intra-aortic balloon pump was placed, and the patient was sent for urgent coronary bypass and mitral valve replacement. Surgical visualization of the mitral valve revealed complete rupture of the posterior-medial papillary muscle. After an initial tenuous postoperative course, the patient continued toward a full recovery.

View larger version (179K): [in this window] [in a new window]   Left ventriculogram demonstrates grade 4+ mitral regurgitation. Note opacification of all 4 pulmonary veins (1, right inferior pulmonary vein; 2, right superior pulmonary vein; 3, left superior pulmonary vein; 4, left inferior pulmonary vein). Surgical exploration revealed papillary muscle rupture.

	Acknowledgments

 
Disclosures

None.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Szczytowski, J. M. Articles by Lawrence, M. E. Search for Related Content PubMed PubMed Citation Articles by Szczytowski, J. M. Articles by Lawrence, M. E. Related Collections Other diagnostic testing Acute myocardial infarction