Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

Cholestasis of Pregnancy Chordae Tendineae Rupture 309

follow-up

■Cholestasis resolves with delivery

■No sequellae other than a slight increase in risk for gall stones

complications and prognosis

■Increased risk of prematurity/stillbirth

Chordae Tendineae Rupture............................

JUDITH A. WISBESKI, MD

history & physical

History

■Idiopathic

■Endocarditis

■Trauma

■Connective tissue disorders

■Rheumatic heart disease

■Congenital

■Sudden onset of pulmonary congestion or acute pulmonary edema

■Chest pain may be present

Signs & Symptoms

■Crescendo early or mid systolic murmur, radiates to base of heart

(rupture of chordae to posterior leaflet) or radiates to spine (rupture

of chordae to anterior leaflet)

■Signs of pulmonary congestion

■Hypotension may be present

tests

■ECG

➣May be normal

■Blood

➣Cardiac enzymes usually normal

■Chest X-Ray

➣Heart size may be normal

➣Normal left atrial size

➣Pulmonary congestion present

■Echo/Doppler

➣Detects and quantitates mitral regurgitation

➣Flail mitral valve leaflet may be visualized