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A 67-year-old woman presented with a 3-month history of progressive exertional dyspnea. Her blood pressure was 132/50, and her pulse was 74 beats per minute. Examination revealed a large-volume collapsing pulse, a short-ejection systolic murmur terminating well before the second heart sound, an early diastolic decrescendo murmur, and a mid-diastolic murmur audible over the cardiac apex (an Austin Flint murmur). She had had rheumatic fever in childhood. A magnetic resonance image of the heart reveals a central, high-velocity jet, due to aortic-valve incompetence (Panel A, arrows), projecting into the left ventricular cavity. The jet clearly strikes the anterior mitral-valve leaflet . . . [Full Text of this Article] |
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