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Case #1
The Case
- WM is an 80-year-old with hypertension, chronic atrial fibrillation,
aortic insufficiency and mitral regurgitation.
- He speed walks 3 times per week.
- He presented with new onset exertional dyspnea.
- He denied any chest pain with this.
- His exam was significant for normal blook pressure and irregularly
irregular heart sounds with a systolic ejection murmer radiating to
the axilla.
- His EKG showed atrial fibrillation with mild S-T depression laterally
The Clinician's Thoughts
- Is this new onset dyspnea?
- Silent ischemia without chest pain?
- Perhpas he has such bad valvular disease that it is decompensating
and getting worse.
- Perhaps it is uncontrolled atrial fibrillation during exercise.
- How valuable would a stress test be to rule out ischemia?
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