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A 72-year-old woman with diabetes mellitus, hypertension, and peripheral vascular disease was hospitalized with chest tightness and acute shortness of breath. She reported a four-month history of worsening dyspnea on exertion, orthopnea, and a progressive whitening of her fingernails. Physical examination revealed an elevated jugular venous pressure, an S4 gallop rhythm, bilateral pulmonary rales, peripheral pitting edema, and complete whitening of the nail units of her hands and feet. Laboratory investigations showed a normal complete blood count, as well as normal renal and liver function. Electrocardiography revealed deep T-wave inversions in leads V1 through V3. Echocardiography showed an ejection . . . [Full Text of this Article] |
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