{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:00Z","timestamp":1784557020676,"version":"3.55.0"},"reference-count":10,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T00:00:00Z","timestamp":1656633600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Graves\u2019 disease can have multiple cardiac manifestations. A rare complication is that of severe mitral regurgitation secondary to mitral valve chordae rupture, due to both compromise of valve integrity by deposition of glycosaminoglycans and the hemodynamic stresses of thyrotoxicosis. Pregnancy, with its related hemodynamic changes, is another setting in which mitral valve chordae rupture has occasionally been documented. We present a unique case of a 36-year-old female with uncontrolled Graves\u2019 disease who presented during pregnancy at 13 weeks gestation with atrial flutter and features of congestive heart failure. Echocardiogram found severe mitral regurgitation secondary to a ruptured mitral chord. She was treated conservatively with diuresis and ultimately delivered her baby without complication at 28 weeks when she had preterm premature rupture of membranes. She is currently on methimazole and propranolol and pending definitive management of her Graves\u2019 disease. This represents not only a rare cardiac complication in a patient with Graves\u2019 disease but also is the first in the literature, to our knowledge, which describes this complication in a pregnant patient with Graves\u2019 disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Thyroid disease can have multiple effects on the heart through hemodynamic and structural changes and can result in heart failure, arrhythmias, valvular disease, and pulmonary hypertension.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Graves\u2019 disease can cause glycosaminoglycan deposition in valvular tissue resulting in fragile leaflets that can rupture with little stress.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Pregnancy and thyrotoxicosis have similar hemodynamic consequences with increased cardiac output and reduced systemic vascular resistance.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Be vigilant in those with hyperthyroidism with a new murmur or features of acute heart failure, as a ruptured valve chord can result in increased morbidity and mortality if not recognized and addressed quickly.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-22-0298","type":"journal-article","created":{"date-parts":[[2022,7,27]],"date-time":"2022-07-27T07:46:14Z","timestamp":1658907974000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":2,"title":["Mitral valve chord rupture in a pregnant patient with uncontrolled hyperthyroidism"],"prefix":"10.1530","volume":"2022","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5338-7251","authenticated-orcid":true,"given":"Tamaryn","family":"Fox","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza","family":"Akhtar","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nissa","family":"Blocher","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Anastasopoulou","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Circulation","first-page":"e35","article-title":"2020 ACC\/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology\/American Heart Association Joint Committee on clinical practice guidelines","volume":"143","author":"Otto","year":"2021","unstructured":"Otto CMNishimura RABonow ROCarabello BAErwin JP3rdGentile FJneid HKrieger EVMack MMcLeod C2020 ACC\/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology\/American Heart Association Joint Committee on clinical practice guidelines. Circulation2021143e35\u2013e71. (https:\/\/doi.org\/10.1161\/CIR.0000000000000932). Erratum in: Circulation2021143 e228. Erratum in: Circulation2021143 e784."},{"key":"bib2","series-title":"Circulation: Heart Failure","article-title":"Intersection of heart failure and pregnancy: beyond peripartum cardiomyopathy","volume":"14","author":"DeFilippis","year":"2021","unstructured":"DeFilippis EMHaythe JHWalsh MNKittleson MM. Intersection of heart failure and pregnancy: beyond peripartum cardiomyopathy. Circulation: Heart Failure202114 e008223. (https:\/\/doi.org\/10.1161\/CIRCHEARTFAILURE.120.008223)"},{"key":"bib3","series-title":"Nature Reviews: Endocrinology","first-page":"431","article-title":"Cardiovascular involvement in patients with different causes of hyperthyroidism","volume":"6","author":"Biondi","year":"2010","unstructured":"Biondi BKahaly GJ. Cardiovascular involvement in patients with different causes of hyperthyroidism. Nature Reviews: Endocrinology20106431\u2013443. (https:\/\/doi.org\/10.1038\/nrendo.2010.105)"},{"key":"bib4","series-title":"Comprehensive Physiology","first-page":"1325","article-title":"Cardiac physiology of pregnancy","volume":"5","author":"May","year":"2015","unstructured":"May LCardiac physiology of pregnancy. Comprehensive Physiology201551325\u20131344. (https:\/\/doi.org\/10.1002\/cphy.c140043)"},{"key":"bib5","series-title":"British Heart Journal","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1136\/hrt.34.5.541","article-title":"Acute mitral regurgitation in pregnancy due to ruptured chordae tendineae","volume":"34","author":"Caves","year":"1972","unstructured":"Caves PKPaneth M. Acute mitral regurgitation in pregnancy due to ruptured chordae tendineae. British Heart Journal197234541\u2013544. 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(https:\/\/doi.org\/10.1016\/j.cpcardiol.2015.04.002)10.1016\/j.cpcardiol.2015.04.002"},{"key":"bib8","series-title":"Journal of the Endocrine Society","doi-asserted-by":"publisher","first-page":"1246","DOI":"10.1210\/js.2018-00173","article-title":"Severe mitral regurgitation as a result of rupture of mitral valve chordae tendineae in a patient with Graves disease","volume":"2","author":"Karashima","year":"2018","unstructured":"Karashima STsuda TKometani MOka RDemura MKawashiri MATakeda YHayashi KYoneda T. Severe mitral regurgitation as a result of rupture of mitral valve chordae tendineae in a patient with Graves disease. Journal of the Endocrine Society201821246\u20131250. 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(https:\/\/doi.org\/10.1016\/j.ajem.2018.03.038)10.1016\/j.ajem.2018.03.038"}],"container-title":["Endocrinology, Diabetes &amp; Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2022\/1\/EDM22-0298.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2022\/1\/EDM22-0298.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2022\/1\/EDM22-0298.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:47:59Z","timestamp":1784555279000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/3425"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,1]]},"references-count":10,"URL":"https:\/\/doi.org\/10.1530\/edm-22-0298","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,1]]}}}