- A 59-YEAR-OLD, 92-kg, 178-cm man with a past medical history of chronic alcohol and tobacco abuse was referred to the authors’ institution by his primary care physician because a routine electrocardiogram found a new right bundle-branch block. The patient denied cardiovascular complaints, but he did report occasional dizziness and dyspnea on exertion that he attributed to age and general deconditioning. The physical examination and laboratory analysis were unremarkable with the exception of pulse oximetry values in the low 90s while the patient was breathing room air.
- A 44-YEAR-OLD, 117-kg, 188-cm previously healthy man was referred to the authors’ institution for evaluation of a new diastolic murmur that was heard during a routine employment physical examination. The patient incidentally reported a 3-month history of occasional dyspnea and dizziness, but these symptoms were not particularly concerning to him nor did they cause him to seek medical attention, limit his weightlifting exercises at the gym, or interfere with his work as a long-distance truck driver.
- A 46-YEAR-OLD, 56 kg, 165 cm man with a history of hypertension, hyperlipidemia, tobacco abuse, transient ischemic attacks, and protein S deficiency was evaluated in a community hospital for acute, severe substernal chest pressure radiating to his left arm, nausea, vomiting, diaphoresis, and dizziness. He denied neurological symptoms. The patient stated that he had not taken any of his prescribed cardiac and anticoagulant medications for three months before admission because he had lost his insurance coverage.
- A 78-YEAR-OLD, 98-kg, 188-cm man with a past medical history of essential hypertension and hyperlipidemia was evaluated in the preoperative clinic of the authors’ institution in preparation for an elective right inguinal herniorrhaphy. The patient denied cardiovascular complaints. The physical examination revealed a grade II of VI diastolic murmur that was heard along the right sternal border; the patient was referred for transthoracic echocardiography as a result. This study revealed a large ascending thoracic aortic aneurysm, moderately severe aortic insufficiency, mild left ventricular (LV) enlargement, and an estimated LV ejection fraction of 45%.
- A 52-YEAR-OLD man with a history of hypertension presented to the authors' institution with the sudden onset of severe anterior chest pain radiating to his abdomen, left leg weakness, and an inability to stand or ambulate. The physical examination indicated that the patient was alert but somewhat disoriented. He did not have a palpable pulse in his left leg and foot but was otherwise hemodynamically stable. The patient was able to move his lower extremities and toes bilaterally. A computed tomography (CT) scan with angiographic contrast was performed because of the history and physical findings.
- A 65-YEAR-OLD MAN with a history of hypertension, hyperlipidemia, and tobacco abuse was admitted to the authors' hospital for the evaluation of postural dizziness, progressive dyspnea on exertion, and intermittent substernal chest pain. Transthoracic echocardiography (TTE) indicated the presence of a heavily calcified, severely stenotic bicuspid aortic valve (AV) with peak and mean pressure gradients across the valve of 102 and 59 mmHg, respectively. The estimated aortic valve area (AVA) was 0.8 cm2.