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A 52-year-old man with chronic left bundle-branch block presented with exertional syncope but no chest pain, palpitations, or dyspnea. His blood pressure was 95/60 mm Hg, and examination revealed signs of right ventricular failure and ascites. Transthoracic echocardiography revealed right ventricular dilatation and hypokinesis, with moderate tricuspid regurgitation and an estimated right ventricular systolic pressure of 55 mm Hg. Doppler studies of the legs showed bilateral proximal deep venous thrombosis, making the diagnosis of pulmonary embolism likely. Paracentesis and cytologic analysis of ascitic fluid revealed metastatic adenocarcinoma. Seven days after presentation, the patient had multiple episodes of arterial desaturation and . . . [Full Text of this Article] |
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