Hypertrophic obstructive cardiomyopathy complicated by ruptured chordae tendinea to the posterior mitral leaflet and severe congestive heart failure.

A 63-year-old woman with hypertrophic obstructive cardiomyopathy developed rapidly progressive fatigue, shortness of breath and congestive heart failure. A transesophageal echocardiogram demonstrated ruptured chordae to the posterior mitral valve leaflet with severe mitral regurgitation. Mitral valve replacement eliminated the outflow gradient. Acute or subacute hemodynamic deterioration in a patient with hypertrophic obstructive cardiomyopathy should lead to a search for associated lesions.