title: Coexistence of dynamic mitral regurgitation and dynamic left ventricular dyssynchrony in a patient with repeated episodes of acute pulmonary edema: improvement with cardiac resynchronization therapy.
abstract: A 69-year-old woman with idiopathic dilated cardiomyopathy and chronic heart failure experienced repeated hospital admissions for acute pulmonary edema with no recognizable precipitating factor. Worsening mitral regurgitation was triggered by exercise echocardiography and significant intraventricular dyssynchrony was elicited by low-dose dobutamine stress echocardiography. After cardiac resynchronization therapy she remained free of hospitalizations for 12 months. This case highlights the dynamic nature of both functional mitral regurgitation and left ventricular dyssynchrony and illustrates how in some patients stress echocardiography can help to clarify clinical scenarios and help with the challenging task of selecting patients who will benefit from cardiac resynchronization therapy.
authors.affiliation: Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal. Electronic address: mariasalomecarvalho@gmail.com.
authors.forename: Maria Salomé
authors.initials: MS
authors.lastname: Carvalho
authors.affiliation: Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Andrade
authors.affiliation: Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
authors.forename: Carla
authors.initials: C
authors.lastname: Reis
authors.affiliation: Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Brito
authors.affiliation: Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
authors.forename: Marisa
authors.initials: M
authors.lastname: Trabulo
authors.affiliation: Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Mendes
mesh_terms: D000208:Acute Disease; D000368:Aged; D058406:Cardiac Resynchronization Therapy; D005260:Female; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000150:complications*; D011654:Pulmonary Edema / Q000150:complications*; D012008:Recurrence; D012074:Remission Induction; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000628:therapy*
keywords: Cardiac resynchronization therapy; Dissincronia ventricular esquerda; Ecocardiografia de stress; Functional mitral regurgitation; Left ventricular dyssynchrony; Regurgitação mitral funcional; Stress echocardiography; Terapêutica de ressincronização cardíaca