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Previous Volume 331:1511-1515 December 1, 1994 Number 22 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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A 77-year-old man with mitral-valve prolapse said he had had insomnia and shortness of breath for five days. A murmur of mitral regurgitation had first been noted nine years earlier.

The patient's mitral regurgitation could have progressed, producing congestive heart failure, but in an elderly man coronary artery disease and a myocardial infarction would surely be possible. I wonder if the patient is a smoker with chronic pulmonary disease. He could have pneumonia, but I would put congestive heart failure first on my list.

He was short of breath when walking across the room, but he had had no chest . . . [Full Text of this Article]

Commentary

Source Information

From the Divisions of Clinical Decision Making and General Internal Medicine, New England Medical Center, Tufts University School of Medicine, Boston.

Address reprint requests to Dr. Pauker at New England Medical Center, Box 302, 750 Washington St., Boston, MA 02111.

References

Related Letters:

Clinical Problem-Solving: Recurrent Pulmonary Emboli
Greenfield L. J., Flachsbart F., Pauker S. G., Kopelman R. I.
Extract | Full Text  
N Engl J Med 1995; 332:1104-1105, Apr 20, 1995. Correspondence

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• Greenberg, D. L., Root, R. K. (1995). Decision Making by Analogy. NEJM 332: 592-596 [Full Text]