A 75-Year-Old Woman with Fatigue and a Longstanding Heart Murmur

Introduction. A 75-year-old woman presents with subacute (1-2 months) onset of easy fatigue and shortness of breath with exercise.

Patient history. There have been no chest pains of any kind, no palpitations, no paroxysmal nocturnal dyspnea or pedal edema. The patient noted that she has no history of smoking or prior cough, hemoptysis or history of chronic obstructive pulmonary disease. However, she is known to have a heart murmur since her 40s, which was initially termed "floppy mitral valve syndrome" but in recent times, was more accurately evaluated by echocardiography as mitral valve prolapse with regurgitation. Following this diagnosis, she has had periodic examinations and echocardiograms. The most recent was about 6 months ago, which showed the mitral valve regurgitant volume approaching 50% of ejection fraction (EF).

She otherwise has always been very healthy and extremely active. She is now a semi-retired dancing schoolteacher. She has 2 grown children and no history of rheumatic fever. She takes no prescription medicines.

Physical examination. The patient’s physical examination reveals a thin woman with BMI 19-20. (Table 1)

Table 1. Physical examination findings