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An apparently healthy 62-year-old man was admitted because of a one-month history of progressive dyspnea on exertion. He reported leg edema, but no orthopnea or paroxysmal nocturnal dyspnea. On physical examination, his oxygen saturation was 94 percent while he was breathing room air, his lungs were clear, and there was no clubbing of the toes, but a harsh, grade 2/6 holosystolic murmur was heard in the aortic area with radiation to the back. The B-type natriuretic peptide level was elevated at 862 pg per milliliter (normal, <100). A subsequent echocardiogram showed global hypokinesis, a left ventricular ejection fraction of 30 . . . [Full Text of this Article] |
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