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- W2056894790 abstract "A 46-year-old Dominican woman was transferred to this hospital for chest pain and dyspnea for 1 week. The patient recently lapsed on her outpatient medications, including amiloride, digoxin, furosemide, metoprolol, spironolactone, and warfarin. The patient had a 25-year history of rheumatic heart disease and underwent prosthetic mitral valve replacement 12 years earlier. On presentation, the patient was found to have a pulse of 80 beats/min while in atrial fibrillation. The physical examination was notable for a 4/6 holosytolic murmur at the left lower sternal border, a loud diastolic rumble at the right upper sternal border, and distended neck veins. Posteroanterior (Figure 1A) and lateral (Figure 1B) chest x-ray studies demonstrated cardiac silhouette enlargement with a “double contour sign” (Figure 1A, arrows) and splaying of the carina (Figure 1A, dotted arrow), indicating left atrial enlargement as well as the presence of multiple left atrial rim-like calcifications (Figure 1A, B, and C, arrowheads) and a prosthetic mitral valve (Figure 1A, B, and C, asterisk). Computed tomography of the chest with intravenous contrast material (Figure 1C, axial image) was completed to further characterize the left atrial enlargement and demonstrated cardiomegaly with a dilated left atrium measuring 12.1 × 8.1 cm, peripheral calcifications (Figure 1C, arrowheads), and two intra-atrial thrombi measuring 8.8 × 5.7 × 5.6 cm and 5.3 × 2.0 × 2.1 cm (Figure 1C, arrow). An echocardiogram demonstrated moderate mitral and aortic regurgitation. Home heart failure medications were resumed and the patient was transitioned to warfarin, with resolution of her chest pain and dyspnea. The patient was scheduled for future mitral and aortic valve replacements." @default.
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- W2056894790 date "2013-06-01" @default.
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- W2056894790 title "Giant Left Atrium in Rheumatic Heart Disease: The Classic Signs of Left Atrial Enlargement" @default.
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- W2056894790 doi "https://doi.org/10.1016/j.jemermed.2012.11.066" @default.
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