Dr. Thomas E. Shea: This 47-year-old housewife entered the hospital because of a heart murmur and shortness of breath. She had been in good health until five years before admission, when she noted the gradual onset of exertional dyspnea and occasional episodes of wheezing. She had no acute problems until one year later when she developed fever and cough for which she was treated with antibiotics. Roentgenograms of the chest at that time were interpreted as showing pulmonary congestion and possibly pneumonia. Physical examination on admission to this hospital revealed the thyroid to be enlarged. The lungs were clear and the heart was moderately enlarged. The cardiac rhythm was regular at 120 beats per minute. There was a grade 2 systolic murmur and a grade 2 diastolic rumble located at the apex. The second pulmonic sound was accentuated. There was no presystolic accentuation, nor was there an opening snap. The
Greene RE. Mitral Regulation. JAMA. 1968;203(8):588–590. doi:10.1001/jama.1968.03140080048012
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