A 25-year-old woman is pregnant. During her first prenatal visit, a right ventricular (RV) heave is felt and there is a blowing, holosystolic murmur that is heard best at the lower left sternal border. What is the most appropriate next step for evaluation of the murmur? Obtain an echocardiogram. Obtain an echocardiogram at her next […]

A 40-year-old restaurant manager is being seen by a cardiologist for progressive shortness of breath and lower extremity edema. On physical examination, blood pressure is 120/80 mmHg, jugular venous distension is 10 cm above the sternal angle with prominent a waves, the heart rhythm is regular, a right ventricular heave is present, and a loud […]

A 62-year-old accountant recently suffered an inferior myocardial infarction for which a stent was placed to his right coronary artery. A week later he is admitted to the hospital with severe fatigue and shortness of breath. On examination, the heart rate is regular at 30 beats per minute. What is the most likely heart rhythm? […]

Mrs. Smith, a 65-year-old female, presents to the clinic complaining of fatigue, weakness, and shortness of breath on exertion for the past few weeks. She reports no significant changes in her diet or exercise routine but mentions a history of heavy menstrual periods. On examination, Mrs. Smith appears pale, with conjunctival pallor noted. Her heart […]

A 45-year-old immigrant from sub-Saharan Africa is admitted to the hospital with several months of shortness of breath, abdominal distension, and pitting lower extremity edema. On physical examination, the jugular venous pressure is estimated at 15 cm above the angle of the sternum and the pressure increases during respiration. A blowing, holosystolic murmur is heard […]