Cardiovascular System

{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This middle aged lady has presented with a diagnostic conundrum. Her history is suggestive of progressively worsening heart failure. However, examination reveals the murmurs of both mitral valve stenosis "},{"insert":"and","attributes":{"bold":true}},{"insert":" mitral valve insufficiency. This combination is unusual, raising suspicion of either congenital or acquired valvular disease (particularly rheumatic heart disease); or a cardiac tumor. \n\nHowever, congenital heart disease and rheumatic heart disease are both clinically less likely, given the age of presentation; and because these would almost certainly have been detected during her previous pregnancies.\n\nEchocardiography is a good next step. This reveals a large mass in the left atrium that prolapses through the mitral valve: almost certainly an atrial myxoma.\n\nCardiac magnetic resonance imaging (MRI) is helpful for detecting intramural attachment and tumor invasion, both of which may affect the therapeutic approach. Fortunately, the tumor"}]}

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