Question:
A 68-year-old man, whose medical history is significant for hypertension
and diabetes mellitus type II, was admitted for constant substernal
chest pressure and exertional dyspnea associated with orthopnea and
bilateral lower extremity edema for one week. His exam was remarkable
for elevated jugular venous pressure, a holosystolic murmur at the left
lower sternal border radiating toward the apex, and 2+ pitting edema in
bilateral lower extremities. Electrocardiogram (EKG) showed Right bundle
branch block with T wave inversions in inferior and anterolateral leads
without a prior EKG for comparison. Serial troponin levels were negative
and the brain-natriuretic peptide level was elevated (535 pg/mL). Chest
radiograph showed cardiomegaly and interstitial edema.