Paravalvular Leak
Paravalvular Leak A 57-year-old man had mechanical mitral valve replacement 3 years ago due to severe mitral regurgitation after endocarditis. Six months later, a significant paravalvular leak was verified, and…
Hypertension and Transient Ischemic Attack
Hypertension and Transient Ischemic Attack A 57-year-old woman from El Salvador has a history of hypertension and transient ischemic attacks. She has an abnormal electrocardiogram shown in Figure 40-1. Figure…
Abrupt Onset Chest Discomfort and Abdominal Pain
Abrupt Onset Chest Discomfort and Abdominal Pain A healthy 56-year-old man was in his usual state of health until he developed the abrupt onset of midsternal chest discomfort and epigastric…
Mitral Valve Repair for Mitral Regurgitation
Mitral Valve Repair for Mitral Regurgitation A 55-year-old man underwent mitral valve repair 3 months ago for symptomatic severe mitral regurgitation. He felt well until last week when he developed…
Diabetes, Hypertension, and Hypercholesterolemia
Diabetes, Hypertension, and Hypercholesterolemia A 54-year-old man has diabetes, hypertension, and hypercholesterolemia. He complains of dyspnea on exertion and has limited his activities. A stress test showed no evidence of…
Weight Loss, Fatigue, Increasing Dyspnea, and Leg Edema
Weight Loss, Fatigue, Increasing Dyspnea, and Leg Edema A 54-year-old man has suffered from weight loss and fatigue for 3 to 6 months and increasing dyspnea for 6 weeks. Leg…
Aortic Valve Replacement after Endocarditis
Aortic Valve Replacement after Endocarditis A 52-year-old man has a past history of bioprosthetic aortic valve replacement secondary to aortic valve endocarditis. He now presents to the hospital with 2…
Familial Hyperlipidemia and Exertional Chest Pain
Familial Hyperlipidemia and Exertional Chest Pain A 52-year-old woman with familial hyperlipidemia complains of exertional chest pain but walks 2 to 5 miles daily without difficulty. She is feeling depressed…
Closure of Patent Foramen Ovale
Closure of Patent Foramen Ovale A 52-year-old woman had a closure of a patent foramen ovale (PFO) with a 30-mm Helex septal occluder (W. L. Gore & Associates, Flagstaff, Arizona)…
Antiphospholipid Antibody Syndrome
Antiphospholipid Antibody Syndrome A 50-year-old woman with a history of antiphospholipid antibody syndrome, a history of ST segment elevation (Q wave) myocardial infarction involving the left anterior descending artery, history…
