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Fifty-seven-year-old man with progressive dyspnoea
  1. Nikoloz Koshkelashvili,
  2. Priya Kohli,
  3. Jason Linefsky
  1. Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr Nikoloz Koshkelashvili, Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, USA; nkoshke{at}emory.edu

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Clinical introduction

A 57-year-old man from the USA with a history of atrial fibrillation and hypertension was evaluated for progressive dyspnoea and decreased energy. The patient denied a history of congestive heart failure, systemic symptoms or myocardial infarction. He was found to have a 3/6 holosystolic murmur radiating to the axilla. Transthoracic echocardiography (TTE) reported a reduced ejection fraction of 40%, mitral valve regurgitation and absence of interatrial shunts. The remaining cardiac valves were without abnormality. A nuclear stress test reported 18% fixed inferolateral defect. Subsequent coronary angiography was negative for obstructive coronary artery disease. To better …

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