Freya Rumis

 

PATIENT: Freya Rumis 1966

 

HISTORY: asymptomatic thrill palpated over left cardiac apex, sudden onset, grade 5 murmur, systolic, PMI L apex

CHARGES: echocardiography

 

Abdominal U/S

 

Not Applicable

Echocardiography

SUMMARY

This is an unusual presentation which on first evaluation does not appear to correspond with the cardiac ultrasound – a severe regurgitation or turbulence would normally be expected to cause a thrill. In this case I wonder if the presence of a markedly eccentric mitral regurgitant jet – virtually perpendicular to mitral inflow axis – combined with the thin-chested conformation of the patient – could exacerbate the thrill; the jet in this case would make contact with the heart immediately adjacent to the chest wall directly, in a perpendicular nature. Repeat evaluation in 6 weeks is advised – the prolapse motion of the free wall leaflet of the mitral valve in conjunction with the eccentric nature of the jet and the reported sudden onset raise concern for the possibility of a chordae rupture and so rate of progression should be monitored.

B-MODE

 

Comments: cardiac chambers, valves and outflow tracts appear normal with the exception of the mitral valve which is thickened and irregularand the free wall leaflet displays prolapse motion

LA:Aortic ratio (RPS SA, normal <1.6) 1.5

 

LA:Ao ratio (RPS LA, normal <2.5) 1.9

 

M-MODE

 

FS 38%, EPSS 0.1cm.

 

WALL THICKNESS AND CHAMBER DIMENSIONS COMMENTS: lvdd 3.3cm

 

COLOUR DOPPLER

 

markedly eccentric mitral regurgitant jet, mild, extending along septal aspect

 

SPECTRAL DOPPLER

 

MITRAL INFLOW: E 0.8m/s A 0.4m/s. Mitral Regurgitation? yes very eccentric and perpendicular to probe

 

AORTIC OUTFLOW: Max Velocity 1.1m/s. Aortic Insufficiency? no

 

TRICUSPID INFLOW: Tricuspid Insufficiency? no

 

PULMONIC OUTFLOW Max Velocity 1m/s. Pulmonic Insufficiency? no

 


U/S Guided Samples: Results

Not Applicable.

ECG
Not Applicable.

Endoscopy
Not Applicable.

Other

Not Applicable

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