Acute mitral regurgitation

In other conditions of cardrogenic shock (due to mechanical abnormalities) e.g. acute mitral regurgitation or ventricular septal defect, surgical correction is usually required. 

It is indicated in hypertensive crisis, congestive heart failure and acute mitral regurgitation. 

LiddicoatJR, Mac Neill BD, Gillinov AM, et al. Percutaneous mitral valve repair a feasibility study in an ovine model of acute ischemic mitral regurgitation. Catheter Cardiovasc Interv 2003 60 410-416. 

Maniu CY Patel JB, Reuter DG, et al. Acute and chronic reduction of functional mitral regurgitation in experimental heart failure by percutaneous mitral annuloplasty. J Am Coll Cardiol 2004 44 1652-1661. 

By shortening AV delay and reducing LV dyssynchrony, CRT can increase LV filling time, increase sttoke volume, and reduce mitral regurgitation (5,10,11). These are the underlying mechanism of acute improvement with CRT. In fact, patients frequently feel better almost immediately after implantation. Occasionally, we see patients with end-stage heart failure who cannot be weaned off inotropic support be successfully weaned 1-2 days after CRT implantation. 

A 49-year-old woman who took low-dose per-golide (0.625 mg/day) daily for 5 years for restless legs syndrome developed chronic and then acute heart failure and had moderate to severe aortic and mitral regurgitation, requiring replacement of both valves [101 ]. 

A 22-year-old man with ulcerative colitis was started on therapy with both oral (1.6 g, twice daily) and rectal (2 g, at bedtime) mesalazine. After 20 days, the patient developed fever, chest pain and dyspnoea. Laboratory tests revealed leukocytosis, with elevation of inflammatory indexes and cardiac troponin 1. Electrocardiogram displayed sinus tachycardia, inverted T-waves in inferior and left precordial leads. Echocardiography showed a mildly dilated left ventricle, diffuse hypokinesis and mild mitral regurgitation without pericardial effusion. A diagnosis of acute myocarditis was made and mesalazine was discontinued. Cardiac symptoms improved within few days. About... 

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