Sudden-onset breathlessness in a middle-aged man

Clinic introduction A middle-aged man presented to the emergency department with sudden breathlessness and chest discomfort for the last 2 hours. He had a tall thin habitus and was anxious, diaphoretic and orthopneic. Vitals revealed tachycardia with a heart rate of 124 bpm and blood pressure of 155/60 mm Hg. On auscultation, a soft apical holosystolic murmur propagating to the base and into the neck was heard. ECG showed sinus tachycardia with no dynamic ST-segment changes on serial ECGs. Serial troponins were within normal limits. Chest X-ray revealed features of acute pulmonary oedema. Echocardiography showed non-coaptating mitral leaflets with severe mitral regurgitation. After initial stabilisation, transoesophageal echocardiography was performed (figure 1A–D). Figure 1Transoesophageal echo images, 2D and 3D. Question What is the most appropriate treatment for the findings shown? Vancomycin, gentamycin, cefepime for 6 weeks and mitral...
Source: Heart - Category: Cardiology Authors: Tags: Image challenges Source Type: research