from sleep. Over the past several weeks, she has been complaining of increased bilateral pedal edema, shortness of breath, and fatigue.
When she stands from sitting, she predictably becomes dizzy, which now happens at
times even while sitting or lying down.
She has no back pain, abdominal pain, fever, nausea, diaphoresis, or confusion.
Her primary physician prescribed her a loop diuretic and a beta blocker last month
for the same symptoms; after some initial improvement, her symptoms have
In the ED, T 99.9 F HR 68 BP 110/90 RR 22 SpO2 98% RA. In general, she is a fatigued, uncomfortable woman in mild respiratory distress. Her pulmonary exam shows low tidal volume with clear breath sounds. Her heart exam is significant for a late-systolic ejection murmur, with radiation to the right neck. You think you hear an S4. She has trace edema to bilateral ankles.
Your patient’s ECG shows non-specific T wave flattening.
Regarding her presentation, which of the following statements is FALSE?
A. Left ventricular outflow obstruction causes concentric ventricular hypertrophy
B. Fusion of valvular commissures or leaflet thickening are the most common
C. This is a structural calcific process not associated with coronary artery disease
D. There is beat-to-beat variation in cardiac output
In the meantime, a quote –
It is not a case we are treating; it is a living, palpitating, alas, too often suffering fellow creature.
– John Brown (1810-1882), Edinburgh physician and author