Case Study

Myocardial Rupture

A 75 year old female patient presented to the ER with anasarca edema. She had a history of permanent atrial fibrillation and hypertension.

On clinical examination increased jugular venous pressure and a holosystolic murmur was noted. Bedside examination with KOSMOS revealed significantly dilated right heart chambers and massive tricuspid regurgitation due to lack of coaptation of the tricuspid valve leaflets.

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Parasternal short axis Dilated Right Ventricle

PLAX view showing dilated right ventricle.

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Parasternal short axis Lack of coaptation of Tricuspid Valve at Mitral Valve level

PSAX at the level of papillary muscles demonstrating severely dilated right ventricle. D-shape interventricular septum due to pressure and volume overload from right heart chambers is seen. There is also mild pericardial effusion.

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Parasternal short axis Tricuspid Valve with color Doppler at Mitral Valve level

PSAX at the level of the mitral valve shows dilated tricuspid valve annulus and apical displacement of the tricuspid valve leaflets due to remodeling of the right ventricle. These changes result in lack of coaptation of the tricuspid valve leaflets and massive tricuspid regurgitation (4).

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5 Chamber view of severely dilated right heart chambers

Apical 4 chamber view demonstrating severely dilated right heart chambers and massive tricuspid regurgitation due to lack of coaptation of the tricuspid valve leaflets.

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Apical 4 chamber view Tricuspid Valve Regurgitation

Dilated inferior vena cava with minimal respiratory variation is noted.

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Apical 4 chamber view Tricuspid Valve Regurgitation

Dilated inferior vena cava with minimal respiratory variation is noted.

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