Acute severe mitral regurgitation can present atypically as diffuse alveolar hemorrhage and cardiogenic shock, requiring emergent mechanical circulatory support and valve replacement.
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Alerts clinicians to diffuse alveolar hemorrhage as possible acute severe MR presentation; case report leaves open diagnostic protocols.
We describe acute mitral valve regurgitation in a young, previously healthy male patient presenting with diffuse alveolar hemorrhage. The patient initially presented with acute respiratory failure with refractory arterial hypoxemia despite mechanical ventilation. Bronchoscopy showed diffuse alveolar hemorrhage. The patient quickly developed cardiogenic shock, which required vasopressor infusion. Echocardiography showed severe mitral regurgitation and myxomatous mitral valve with anterior leaflet prolapse along with chordal rupture involving the anterior leaflet, which was flail. An Impella device was emergently placed, and the patient underwent mitral valve replacement with subsequent quick resolution of all symptoms.
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Khalil et al. (2022) studied this question.
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