Maini Rohit, Lim Jonathan, Liu Jing, Birnbaum Itamar, Mirza Farooq, Lakkis Nasser, Hamzeh Ihab
BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEXAS.
Methodist Debakey Cardiovasc J. 2018 Jan-Mar;14(1):63-65. doi: 10.14797/mdcj-14-1-63.
A 50-year-old man presented with acute onset dyspnea following cocaine use. He had severe aortic stenosis (AS), mild mitral regurgitation (MR) due to mitral valve prolapse, and no coronary artery disease on recent coronary angiography. He was in acute heart failure with signs of impending cardiogenic shock. Urgent bedside echocardiography revealed hyperdynamic left ventricular systolic function with acute severe MR from a ruptured chordae tendineae. The acute cocaine-induced spike of his already elevated left ventricular systolic pressure from severe AS likely precipitated chordal rupture of his vulnerable mitral valve. This patient underwent emergent mitral and aortic valve replacements. Although cocaine use has been associated with a myriad of cardiovascular complications, acute MR due to chordal rupture has not, to our knowledge, been previously reported in this setting. Prompt diagnosis with echocardiography and surgical intervention are of paramount importance in the management of acute MR.
一名50岁男性在使用可卡因后出现急性呼吸困难。他患有严重的主动脉瓣狭窄（AS），因二尖瓣脱垂导致轻度二尖瓣反流（MR），近期冠状动脉造影显示无冠状动脉疾病。他处于急性心力衰竭状态，有即将发生心源性休克的迹象。紧急床旁超声心动图显示左心室收缩功能亢进，伴有腱索断裂导致的急性严重MR。严重AS已使他的左心室收缩压升高，而急性可卡因诱发的血压飙升可能促使其脆弱的二尖瓣腱索破裂。该患者接受了紧急二尖瓣和主动脉瓣置换术。尽管使用可卡因与众多心血管并发症有关，但据我们所知，此前尚未有在这种情况下因腱索断裂导致急性MR的报道。超声心动图的快速诊断和手术干预在急性MR的治疗中至关重要。
