Abstract

A 50-year-old female with non-cardiac history diagnosed diabetic and hypertensive 6 years ago which was being treated with atenolol and captopril presented to our institution with persistent recurrent fever dyspnea and intermittent chest pain and with exertion. His echocardiogram showed ejection fraction (EF) of 56%, no regional wall motion abnormalities, sever mitral regurgitation, and trivial tricuspid regurgitation. Despite this treatment, she had recurrent episodes of paroxysmal symptomatic controlled atrial fibrillation and hypertensive crises with requiring multiple emergency department visits and hospital admissions.

Introduction

An 50 -year-old man presented to our institution complaining of recurrent fever and a mitral regurgitation murmur. He has a past history significant for paroxysmal atrial fibrillation being treated with drug rate control as atenolol and calcium channel blocker drugs as ( isopten ) 15 days ago, hypertension, hyperlipidemia, obstructive sleep diverticulosis and diverticulitis . her lab was normal and renal function was normal . (urea. creatine . uric acid) and so no adrenal or parenchymal kidney disease with normal renal artery flow she underwent a transthoracic echocardiogram which showed normal left ventricular size and no wall motion abnormalities, LVEF of 56%, severe mitral regurgitation due to incomplete cooptation of the mitral valve leaflets, trivial tricuspid regurgitation, and no pericardial effusion. A transesophageal echocardiogram confirmed restricted mitral valve leaflets resulting in incomplete cooptation and severe mitral regurgitation). No vegetation were seen. Blood cultures ruled out endocarditis as the cause of fever, and he was later found to have. leukemia

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