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Diastolic mitral and tricuspid regurgitation in a patient with 2:1 AV block
International Journal of Cardiology 195 (2015) 111–112
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the editor
Diastolic mitral and tricuspid regurgitation in a patient with 2:1 AV block Uğur Aksu a,⁎, Selim Topcu a, Oktay Gulcu a, Kamuran Kalkan b, Ibrahim Halil Tanboga a a b
Atatürk University Faculty of Medicine Department of Cardiology, Erzurum, Turkey Malkara State Hospital Department of Cardiology, Tekirdağ, Turkey
a r t i c l e
i n f o
Article history: Received 15 May 2015 Accepted 17 May 2015 Available online 22 May 2015 Keywords: Diastolic mitral regurgitation AV block
Diastolic mitral regurgitation (DMR) and diastolic tricuspid regurgitation (DTR) have been reported in patients with atrio-ventricular (AV) block [1,2]. The increased left ventricular diastolic pressure after the atrial contraction with a non-compliant ventricle may lead to transmitral pressure gradient inversion during atrial relaxation. We present a case of diastolic mitral and tricuspid regurgitation in AV block [3].
51-year-old female patient was admitted to our clinic with complaints of dizziness and fatigue. Her medical history, she has been prescribed nebivolol for palpitations. On physical examination, her blood pressure was 100/60, her pulse rate was 36 bpm and respiratory rate was 13/min. Electrocardiography (ECG) showed 2:1 AV block. She was transferred to intensive care unit immediately. Transthoracic echocardiography (TTE) with ECG records was performed. TTE revealed normally left ventricular function with moderate mitral and tricuspid regurgitation. Doppler recordings of the transmitral flow showed retrograde flow into the left atrium after the blocked P-wave, that indicates holodiastolic mitral regurgitation. DMR was diagnosed. In hospital follow up AV block did not recover to sinus rhythm. Permanent pacemaker was implanted to patient and then diastolic mitral regurgitation improved. AV conduction abnormalities are a well-known cause of diastolic DMR regurgitation. The mechanism for DMR is a reversal in the AV gradient during diastole and the same pathophysiological mechanism accounts for the development of DTR. DMR improves after treatment of AV block [1,4–6].
Fig. 1. Diastolic mitral and tricuspid regurgitation from apical four chamber view.
⁎ Corresponding author at: Atatürk University, Faculty of Medicine Department of Cardiology, Yakutiye Training and Research Hospital, Erzurum, Turkey. E-mail address: [email protected] (U. Aksu).
http://dx.doi.org/10.1016/j.ijcard.2015.05.091 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
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U. Aksu et al. / International Journal of Cardiology 195 (2015) 111–112
Fig. 2. Doppler echocardiography with ECG records showed diastolic mitral and tricuspid regurgitation after the blocked atrial contraction.
Conflict of interest There is no conflict of interests. (See Figs. 1 and 2.) Appendix A. Supplementary data Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.ijcard.2015.05.091. References [1] A. Bouzas-Mosquera, A. Garcia-Campos, N. Alvarez-Garcia, Diastolic atrioventricular regurgitation, Arch. Cardiovasc. Dis. 102 (2009) 797–798.
[2] S. Rosanio, E.R. Schwarz, D.L. Ware, A. Vitarelli, Syncope in adults: systematic review and proposal of a diagnostic and therapeutic algorithm, Int. J. Cardiol. 162 (2013) 149–157. [3] T.R. Downes, A.M. Nomeir, B.T. Hackshaw, L.J. Kellam, L.E. Watts, W.C. Little, Diastolic mitral regurgitation in acute but not chronic aortic regurgitation: implications regarding the mechanism of mitral closure, Am. Heart J. 117 (1989) 1106–1112. [4] Y. Agmon, W.K. Freeman, J.K. Oh, J.B. Seward, Diastolic mitral regurgitation, Circulation 99 (1999) e13. [5] R.L. Berger, E. Katz, P. Tunick, I. Kronzon, The ‘A-dip’ of diastolic mitral regurgitation: an unusual Doppler flow pattern in a patient with severe aortic insufficiency and complete heart block, Eur. J. Echocardiogr. 9 (2008) 69–71. [6] V.K. Marrison, A. Fletcher, S.W. Parry, The older patient with syncope: practicalities and controversies, Int. J. Cardiol. 155 (2012) 9–13.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the editor
Diastolic mitral and tricuspid regurgitation in a patient with 2:1 AV block Uğur Aksu a,⁎, Selim Topcu a, Oktay Gulcu a, Kamuran Kalkan b, Ibrahim Halil Tanboga a a b
Atatürk University Faculty of Medicine Department of Cardiology, Erzurum, Turkey Malkara State Hospital Department of Cardiology, Tekirdağ, Turkey
a r t i c l e
i n f o
Article history: Received 15 May 2015 Accepted 17 May 2015 Available online 22 May 2015 Keywords: Diastolic mitral regurgitation AV block
Diastolic mitral regurgitation (DMR) and diastolic tricuspid regurgitation (DTR) have been reported in patients with atrio-ventricular (AV) block [1,2]. The increased left ventricular diastolic pressure after the atrial contraction with a non-compliant ventricle may lead to transmitral pressure gradient inversion during atrial relaxation. We present a case of diastolic mitral and tricuspid regurgitation in AV block [3].
51-year-old female patient was admitted to our clinic with complaints of dizziness and fatigue. Her medical history, she has been prescribed nebivolol for palpitations. On physical examination, her blood pressure was 100/60, her pulse rate was 36 bpm and respiratory rate was 13/min. Electrocardiography (ECG) showed 2:1 AV block. She was transferred to intensive care unit immediately. Transthoracic echocardiography (TTE) with ECG records was performed. TTE revealed normally left ventricular function with moderate mitral and tricuspid regurgitation. Doppler recordings of the transmitral flow showed retrograde flow into the left atrium after the blocked P-wave, that indicates holodiastolic mitral regurgitation. DMR was diagnosed. In hospital follow up AV block did not recover to sinus rhythm. Permanent pacemaker was implanted to patient and then diastolic mitral regurgitation improved. AV conduction abnormalities are a well-known cause of diastolic DMR regurgitation. The mechanism for DMR is a reversal in the AV gradient during diastole and the same pathophysiological mechanism accounts for the development of DTR. DMR improves after treatment of AV block [1,4–6].
Fig. 1. Diastolic mitral and tricuspid regurgitation from apical four chamber view.
⁎ Corresponding author at: Atatürk University, Faculty of Medicine Department of Cardiology, Yakutiye Training and Research Hospital, Erzurum, Turkey. E-mail address: [email protected] (U. Aksu).
http://dx.doi.org/10.1016/j.ijcard.2015.05.091 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
112
U. Aksu et al. / International Journal of Cardiology 195 (2015) 111–112
Fig. 2. Doppler echocardiography with ECG records showed diastolic mitral and tricuspid regurgitation after the blocked atrial contraction.
Conflict of interest There is no conflict of interests. (See Figs. 1 and 2.) Appendix A. Supplementary data Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.ijcard.2015.05.091. References [1] A. Bouzas-Mosquera, A. Garcia-Campos, N. Alvarez-Garcia, Diastolic atrioventricular regurgitation, Arch. Cardiovasc. Dis. 102 (2009) 797–798.
[2] S. Rosanio, E.R. Schwarz, D.L. Ware, A. Vitarelli, Syncope in adults: systematic review and proposal of a diagnostic and therapeutic algorithm, Int. J. Cardiol. 162 (2013) 149–157. [3] T.R. Downes, A.M. Nomeir, B.T. Hackshaw, L.J. Kellam, L.E. Watts, W.C. Little, Diastolic mitral regurgitation in acute but not chronic aortic regurgitation: implications regarding the mechanism of mitral closure, Am. Heart J. 117 (1989) 1106–1112. [4] Y. Agmon, W.K. Freeman, J.K. Oh, J.B. Seward, Diastolic mitral regurgitation, Circulation 99 (1999) e13. [5] R.L. Berger, E. Katz, P. Tunick, I. Kronzon, The ‘A-dip’ of diastolic mitral regurgitation: an unusual Doppler flow pattern in a patient with severe aortic insufficiency and complete heart block, Eur. J. Echocardiogr. 9 (2008) 69–71. [6] V.K. Marrison, A. Fletcher, S.W. Parry, The older patient with syncope: practicalities and controversies, Int. J. Cardiol. 155 (2012) 9–13.