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Abstract
A 43-year-old woman experienced exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea; symptoms had developed within a three-week period. She was diagnosed with mitral regurgitation and left-sided congestive heart failure. Treatment with furosemide, fosinopril, and digoxin improved all symptoms except exertional dyspnea.
She appeared to be healthy, with a pulse of 90; blood pressure, 132/78; respirations, 22; and temperature, 37.2°C. The only notable physical finding was an apical holosystolic murmur (grade 4) that radiated to the axilla. A chest x-ray showed only slight cardiac enlargement; however, an echocardiogram revealed some enlargement of right and left ventricles, moderate hypokinesis of the left ventricle, a localized aneurysm-like area of a kinesis in the high lateral area of the left ventricle, and severe mitral regurgitation without apparent anatomic abnormality of the valve. The ECG is shown.