![]() The patient underwent an aortic-valve replacement the pathological specimens that were obtained showed cystic medial necrosis consistent with the degeneration of aging. Cardiac catheterization demonstrated normal coronary arteries. The left ventricle was enlarged, with an end-diastolic diameter of 90 mm, an end-systolic diameter of 61 mm, and an ejection fraction of 51 percent. Echocardiography showed a dilation of the aortic root, annuloaortic ectasia, severe aortic regurgitation, and mild tricuspid and mitral regurgitation. Cardiac examination revealed decreased S1 and increased S2 intensity, with a grade 2/6 systolic murmur and a grade 3/6 diastolic murmur along the left sternal border. The blood pressure was 164/49 mm Hg (with a pulse pressure of 120 mm Hg), the radial pulses were bounding (Corrigan's pulse), and the carotid pulses were prominent ( Video Clip). There were no features of Marfan's syndrome. He came to the emergency room with exertional dyspnea that had worsened during the preceding week. VideoĪ 66-year-old man with a medical history notable only for locally treated prostate cancer presented with a two-month history of dyspnea on moderate exertion and repeated episodes of angina with mild effort or at rest. The patient has done well, with full resolution of the dyspnea and angina. The most trusted, influential source of new medical knowledge and clinical best practices in the world.Ī 66-year-old man with a medical history notable only for locally treated prostate cancer presented with a two-month history of dyspnea on moderate exertion and repeated episodes of angina with mild effort or at rest. Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. ![]() ![]() The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
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