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A man in his 70s presents with fatigue, dyspnoea and recurrent atrial fibrillation. Pertinent history includes coronary artery disease status post coronary artery bypass grafting, concomitant Maze procedure, mitral valve repair with a 26 mm Edwards mitral annuloplasty ring 9 years earlier and a recent extended beta-lactimase Escherichia coli urinary tract infection that was treated with cefoxitin. Admission was permitted for suspected acute on chronic heart failure with reduced ejection fraction exacerbation and repeat radiofrequency ablation. Physical exam revealed an irregularly, irregular rhythm, holosystolic, murmur best heard at the apex and an S3 gallop. A transesophageal echocardiogram was obtained (see figure 1).
Collaborators Eric Darnell, RCS, RCCS.
Contributors All authors have contributed to the planning, conduct and reporting of the work described in the article. KSP has constructed the overall article content as guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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