A.L., a 68-year-old woman, was admitted to the CCU with chest pain, dyspnea, diaphoresis, syncope, and nausea. She had taken three sublingual doses of nitroglycerine tablets within a 10-minute time span without relief before dialing 911. A previous stress test and thallium uptake scan suggested cardiac disease.
Her family history was significant for cardiovascular disease. Her father died at the age of 62 of an acute myocardial infarction. Her mother had bilateral carotid endarterectomies and a femoral-popliteal bypass procedure and died at the age of 72 of congestive heart failure. A.L.'s older sister died from a ruptured aortic aneurysm at the age of 65. Her ECG on admission presented tachycardia with a rate of 126 bpm with inverted T waves. A murmur was heard at S1. Her skin color was dusky to cyanotic on her lips and fingertips. Her admitting diagnosis was possible coronary artery disease, acute myocardial infarction, and valvular disease.
Cardiac catheterization with balloon angioplasty (PTCA) was performed the next day. Significant stenosis of the left anterior descending coronary artery was shown and was treated with angioplasty and stent placement. Left ventricular function was normal.
Echocardiogram, 2 days later, showed normal-sized left and enlarged right ventricular cavities. The mitral valve had normal amplitude of motion. The anterior and posterior leaflets moved in opposite directions during diastole. There was a late systolic prolapse of the mitral leaflet at rest. The left atrium was enlarged. The impression of the study was mitral prolapse with regurgitation. Surgery was recommended.
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