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