{"pk":39988,"title":"Anterior Mitral Leaflet Flutter on M-mode Echocardiography as an Indicator of Atrial Fibrillation: Case Report","subtitle":null,"abstract":"<p>Introduction.  M-mode in bedside point-of-care ultrasound (POCUS) transthoracic echocardiography (TTE) remains an important tool for emergency physicians.  M-mode of the mitral valve is used to assess ejection fraction (EF) during assessment of E-point septal separation (EPSS).  Anterior mitral leaflet fluttering visualized on M-mode echocardiography is a known sequelae of aortic regurgitation.  Although not reported in the Emergency Medicine literature, anterior mitral leaflet fluttering also occurs with atrial fibrillation.</p>\n<p>Case Report. We present the first case in peer-reviewed Emergency Medicine literature of anterior mitral leaflet fluttering observed on M-mode echocardiography caused by atrial fibrillation.  Our patient was a 54-year-old male with chest pain who was evaluated in the Emergency Department with a point-of-care ultrasound transthoracic echocardiogram that showed anterior mitral leaflet fluttering on E-point septal separation.  Subsequent inpatient workup confirmed the diagnosis of symptomatic atrial fibrillation without ischemia or clinically-significant aortic regurgitation.</p>\n<p>Conclusion.  Emergency physicians must rapidly assess and risk-stratify undifferentiated patients presenting with chest pain.  Understanding that anterior mitral leaflet fluttering on M-mode during EPSS may signal atrial fibrillation augments efficient and appropriate disposition of these patients.</p>\n<p>Keywords. POCUS, point-of-care ultrasound, transthoracic echocardiogram, TTE, M-mode, aortic regurgitation, atrial fibrillation, anterior mitral leaflet flutter, case report</p>","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"POCUS"},{"word":"point-of-care ultrasound"},{"word":"transthoracic echocardiogram"},{"word":"TTE"},{"word":"M-mode"},{"word":"aortic regurgitation"},{"word":"atrial fibrillation"},{"word":"anterior mitral leaflet flutter"},{"word":"case report"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8g57z78k","frozenauthors":[{"first_name":"Maya","middle_name":"","last_name":"Alexandri","name_suffix":"","institution":"Carl R. Darnall Army Medical Center, Department of Emergency Medicine, Fort Cavazos, Texas","department":""},{"first_name":"Adam","middle_name":"","last_name":"Church","name_suffix":"","institution":"Carl R. Darnall Army Medical Center, Department of Emergency Medicine, Fort Cavazos, Texas","department":""},{"first_name":"Chelsea","middle_name":"","last_name":"Ausman","name_suffix":"","institution":"Rhine Ordnance Barracks, Department of Resuscitative Surgery, Rhineland-Palatinate, Germany","department":""},{"first_name":"Dan","middle_name":"","last_name":"Brillhart","name_suffix":"","institution":"Carl R. Darnall Army Medical Center, Department of Emergency Medicine, Fort Cavazos, Texas","department":""}],"date_submitted":"2024-11-24T16:21:35.862000Z","date_accepted":"2025-02-19T19:09:16.549000Z","date_published":"2025-05-01T20:20:00Z","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/39988/galley/35743/download/"}]}