title: Recurrent cardiogenic shock caused by dynamic mitral regurgitation in a patient with hypertrophic obstructive cardiomyopathy: a case report.
abstract: A 68-year-old man with hypertrophic obstructive cardiomyopathy developed recurrent cardiogenic shock due to dynamic mitral regurgitation. The pressure gradient in the left ventricular outflow tract under medication was 30 mmHg, and he complained of no symptom. He developed shock with dyspnea suddenly after bathing and defecation. Echocardiography and left ventriculography revealed massive mitral regurgitation and mild increment of pressure gradient in the left ventricular outflow tract (50 mmHg). He underwent successful mitral valve replacement following treatment with beta-blocker under intraaortic balloon pumping support. This case illustrates that exacerbation of the systolic anterior motion of the mitral anterior leaflet can cause dynamic severe mitral regurgitation with 'mild' increment of pressure gradient in the left ventricular outflow tract, resulting in cardiogenic shock with severe lung edema.
authors.affiliation: Department of Integrated Medicine 1, Omiya Medical Center, Jichi Medical School, Saitama. tomopon@lilac.plala.or.jp
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Nakamura
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ishida
authors.forename: Nahoko
authors.initials: N
authors.lastname: Ikeda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Funayama
authors.forename: Takanori
authors.initials: T
authors.lastname: Yasu
authors.forename: Norifumi
authors.initials: N
authors.lastname: Kubo
authors.forename: Mikihisa
authors.initials: M
authors.lastname: Fujii
authors.forename: Masanobu
authors.initials: M
authors.lastname: Kawakami
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
authors.forename: Muneyasu
authors.initials: M
authors.lastname: Saito
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000628:therapy; D003131:Combined Modality Therapy; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000601:surgery; D011433:Propranolol / Q000627:therapeutic use; D012008:Recurrence; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000628:therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol