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  1. Yehia Saleh1,2,
  2. Abdallah Almaghraby2,
  3. Mohamed Seleem2,
  4. Basma Hammad2
  1. 1 Department of Internal Medicine, Michigan State University, East Lansing, Michigan, USA
  2. 2 Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
  1. Correspondence to Dr Yehia Saleh, yehia.saleh{at}hc.msu.edu

https://doi.org/10.1136/bcr-2018-225266

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    Description

    A 66-year-old female patient with a history of persistent atrial fibrillation and severe mitral stenosis secondary to rheumatic heart disease for which she underwent mitral valve replacement 25 years ago presented with progression of her baseline dyspnoea. On presentation, she had stable vital signs; neck examination revealed bilateral congested neck veins with prominent systolic venous pulsations. Chest and heart auscultation revealed a well-heard mechanical click, a pansystolic murmur heard over the tricuspid area and diminished air entry over the right lung base.

    ECG revealed atrial fibrillation. Laboratory work-up showed that she was adequately anticoagulated but otherwise unremarkable; chest X-ray showed significant cardiomegaly, tracheal shift to the right and obliteration of the right basal lung field (figure 1).

    Figure 1

    Chest X-ray showing significant cardiomegaly, tracheal shift to the right and obliteration of the right basal lung field.

    Echocardiography showed a preserved systolic function, well-functioning mitral valve prosthesis, severe tricuspid regurgitation, severe pulmonary hypertension and …

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    Footnotes

    • Contributors YS worked on the manuscript and was involved in the patient care. AA assisted with writing the manuscript. MS and BH were involved in the patient care, and they revised the manuscript and provided the images.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Next of kin consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.