Key result
Cocaine use in a patient with severe aortic stenosis precipitated an acute spike in left ventricular systolic pressure, resulting in chordal rupture and acute severe mitral regurgitation.
Case Report (n=1)
This case highlights that cocaine use in patients with severe aortic stenosis can precipitate acute chordal rupture and severe mitral regurgitation, necessitating prompt echocardiographic diagnosis and emergent surgical intervention.
Clinicians should consider cocaine exposure in unexplained chordal rupture with aortic stenosis; leaves open frequency and generalizability of this mechanism.
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.
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Maini et al. (2018) conducted a case report in Acute mitral regurgitation and severe aortic stenosis (n=1). Cocaine use was evaluated. Cocaine use in a patient with severe aortic stenosis precipitated an acute spike in left ventricular systolic pressure, resulting in chordal rupture and acute severe mitral regurgitation.
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