Mitral valve dysfunction in a woman with newly diagnosed acute promyelocytic leukemia

Clinical introduction A woman in her mid-40s with a recent diagnosis of pulmonary embolism (on rivaroxaban) presented to the emergency room with dyspnea and fatigue. Vital signs were stable on arrival but a new holosystolic murmur was noted on exam and labs revealed pancytopenia. Infectious workup was unrevealing. CT revealed stable pulmonary emboli compared with prior imaging, along with a new splenic infarct. Transthoracic echocardiography (TTE) (figures 1 and 2, ) demonstrated new findings since the patient’s last normal TTE 3 months prior. Following hospital admission, the patient underwent a bone marrow biopsy which was consistent with acute promyelocytic leukemia (APL) and her course was complicated by multiple embolic strokes and right-sided heart failure requiring inotropic support. Figure 1Transthoracic echocardiography on admission—parasternal long view. Figure 2Transthoracic echocardiography on admission—apical four-chamber view. ...
Source: Heart - Category: Cardiology Authors: Tags: Image challenges Source Type: research