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An elderly woman presented with gross peripheral edema extending to the abdominal wall 2 months after a tissue aortic valve replacement for severe symptomatic aortic stenosis. Her immediate postoperative recovery had been complicated by developing atrial fibrillation associated with an uncontrolled ventricular rate, which was treated with bisoprolol and amiodarone, achieving cardioversion to sinus rhythm on discharge.
Echocardiography demonstrated normal biventricular function with a well-seated, normally functioning aortic valve replacement and moderately severe mitral and tricuspid regurgitation. Preoperatively, she had only mild mitral regurgitation and tricuspid regurgitation. On examination, she had a regular pulse of 60 beats/min and her blood pressure was 120/80 mm Hg. Cannon waves were visible in the jugular venous pressure waveform.
Jackson MWP, Taylor RJ. New-Onset Heart Failure in a Patient With a PacemakerAn Unusual Cause. JAMA Intern Med. 2016;176(1):110-111. doi:10.1001/jamainternmed.2015.6543