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Acute severe mitral regurgitation — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsAcute severe mitral regurgitationSCE Acute Medicine

A 65-year-old woman is assessed on the acute medical unit. She has sudden pulmonary oedema after inferior MI. A new pansystolic murmur is heard at the apex and echocardiography shows a flail leaflet. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely diagnosis?

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Correct answer: D — Acute severe mitral regurgitation

Acute severe mitral regurgitation is the best answer because acute pulmonary oedema with new MR after MI suggests papillary muscle rupture or dysfunction. Hyperkalaemia is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: The murmur can be soft in acute severe MR because pressures equalise rapidly.

Reference: ESC valvular heart disease guideline