Case 31-1992: A 68-Year-Old Man with Acute Mitral Regurgitation

Presentation of Case A 68-year-old man was transferred to this hospital because of an acute myocardial infarct with fever, pulmonary edema, and oliguria. The patient was in stable health until two weeks earlier, when he began to experience fatigue. One day before entry he played golf in the morning and then went to work. Substernal pain soon developed and increased rapidly, with the onset of dyspnea and sweating. He drove himself to another hospital, where an electrocardiogram showed evidence of an acute inferoposterior myocardial infarct. Streptokinase (1.5 million units) was injected by vein, with a continuous intravenous infusion of heparin…