title: Oral Nitrate Administration Ameliorates Cardiogenic Shock due to Eclipsed Mitral Regurgitation.
abstract: Eclipsed mitral regurgitation (MR) has been reported as transient massive functional MR caused by a sudden coaptation defect in the absence of left ventricular remodeling or epicardial coronary artery stenosis. Coronary spasm or microvascular dysfunction has been suggested to be associated with the pathogenesis. Here, we present a 68-year-old woman with eclipsed MR with cardiogenic shock ameliorated by nitrate. She was admitted for transient shock with massive functional MR. Transient MR was associated with a complete absence of mitral leaflet coaptation owing to tethering of the lateral posterior mitral leaflet. The leaflet tethering was triggered by transient myocardial ischemia around the anterolateral papillary muscle, which could have been caused by coronary spasm and/or microvascular dysfunction. During admission, she experienced similar repeated episodes, which were ameliorated by oral nitrate administration. This is the first described case of eclipsed MR with shock ameliorated by nitrate. Although eclipsed MR, a cause of life-threatening shock, is uncommon, we need to keep in mind that nitrate administration could be a treatment option even in patients with cardiogenic shock.
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Mai
authors.initials: M
authors.lastname: Kimura
authors.forename: Takashi
authors.initials: T
authors.lastname: Kohno
authors.forename: Mitsushige
authors.initials: M
authors.lastname: Murata
authors.forename: Tadaki
authors.initials: T
authors.lastname: Nakahara
authors.forename: Kai
authors.initials: K
authors.lastname: Sugihara
authors.forename: Takahiko
authors.initials: T
authors.lastname: Nishiyama
authors.forename: Hikaru
authors.initials: H
authors.lastname: Tsuruta
authors.forename: Toru
authors.initials: T
authors.lastname: Egashira
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Maekawa
authors.forename: Mikihiko
authors.initials: M
authors.lastname: Kudo
authors.forename: Motoaki
authors.initials: M
authors.lastname: Sano
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D000284:Administration, Oral; D000368:Aged; D005260:Female; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D009566:Nitrates / Q000627:therapeutic use*; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D009566:Nitrates