Sudden pulmonary edema, shock and a tricky ECG

Dr. Smithpresented a case of acute severe mitral regurgitation due topapillary muscle rupture. I thought it was worth posting here because there were a lot of pearls. The patient presented in extremis with no immediately apparent reason why, but after adding up the ancillary clues it could hardly be anything else. Also, a repeat 12 lead ECG done minutes later clarified some aspects of what was going on, a great illustration of the Corey Slovis rule “One ECG begets another.”