Ruptured Chordae Tendineae and Acute Pulmonary Edema Induced by Exercise: Occurrence in a Young Man With Mitral Valve Prolapse

AUSCULTATORY or echocardiographic evidence of mitral valve prolapse may be present in up to 10% of healthy individuals. 1,2 Although mitral valve prolapse is generally considered benign, complications are occasionally associated with this condition, including bacterial endocarditis, embolic phenomenon, arrhythmias, and progressive mitral insufficiency. 3 A subset of patients with mitral valve prolapse will develop severe mitral insufficiency directly related to rupture of previously intact chordae tendineae. It has been hypothesized that strenuous exertion may predispose to this complication, 4,5 but there has been no conclusive clinical evidence to support this concern. This report is the first to our knowledge to describe a patient with mitral valve prolapse who developed acute chordal rupture and pulmonary edema related to vigorous exercise. Report of a Case A 26-year-old man was evaluated at another medical center for a "loud" heart murmur, which was discovered during a routine physical examination performed for insurance purposes.