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Acute Mitral Regurgitation - Infective Endocarditis — EECC MCQ

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HardValvular Heart DiseaseAcute Mitral Regurgitation - Infective EndocarditisEECC

Four days after an inferior myocardial infarction, a patient develops shock, pulmonary oedema and a new systolic murmur. Pulmonary-artery catheterisation shows giant wedge-pressure V waves but no right-ventricular oxygen-saturation step-up; echocardiography shows a flail posterior mitral leaflet. Which complication and definitive response are most likely?

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Correct answer: D — Posteromedial papillary-muscle rupture causing acute mitral regurgitation; urgent mitral surgery

Giant wedge V waves and a flail posterior leaflet identify acute severe mitral regurgitation from posteromedial papillary-muscle rupture, a recognised inferior-MI complication requiring urgent surgery after stabilisation. Ventricular-septal rupture would produce a right-ventricular oxygen step-up. Free-wall rupture causes haemopericardium and tamponade rather than a flail leaflet. Right-ventricular infarction produces preload-sensitive shock without giant V waves, while pericarditis does not explain the haemodynamic and valve findings.

Reference: 2023 ESC Guidelines for acute coronary syndromes. https://academic.oup.com/eurheartj/article/44/38/3720/7243210