Intermittent symptomatic functional mitral regurgitation ill
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Abstract
Heart failure (HF) in patients with normal left ventricular ejection fraction accounts for half of the diagnoses of HF. Careful echocardiographic analysis with simultaneous ECG in two patients developing acute heart failure allowed identification of an unusual cause of HF with normal left ventricular ejection fraction (LVEF), but related to sudden reversible functional mitral regurgitation in the absence of significant coronary artery stenosis.

Case
A 54-year-old female was admitted to hospital with acute pulmonary oedema. Her ECG showed sinus tachycardia with left bundle branch block (LBBB) morphology, with a rate of 125 beats per min (bpm). Her symptoms improved following spontaneous conversion to sinus rhythm without LBBB.

Two-dimensional echocardiography revealed concentric left ventricular (LV) hypertrophy with normal systolic function (LVEF 70%), with mild rheumatic mitral regurgitation (MR), mild left atrial dilatation (4.3 cm) and elevated pulmonary artery systolic pressure (50 mmHg). The tenting area of the mitral leaflets and the tenting length was measured as 3.9 cm2 and 1.3 cm, respectively. The mitral annular dimension was 4.2 cm.

The results of her laboratory examination were normal. Her medical history was unremarkable for cardiovascular disease and she was not taking any anti-arrhythmia drugs. Since her symptoms occurred again the following day, the echocardiographic examination was repeated. In the second study, the rhythm was sinus tachycardia with LBBB morphology. The QRS duration was 150 ms....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4683338/
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