SOME FAMILIAR TRADE-OFFS

Stage A 77-year-old man with mitral-valve prolapse said he had had insomnia and shortness of breath for five days. A murmur of mitral regurgitation had first been noted nine years earlier. Response The patient's mitral regurgitation could have progressed, producing congestive heart failure, but in an elderly man coronary artery disease and a myocardial infarction would surely be possible. I wonder if the patient is a smoker with chronic pulmonary disease. He could have pneumonia, but I would put congestive heart failure first on my list. Stage He was short of breath when walking across the room, but he had… © 1994, Massachusetts Medical Society. All rights reserved.