Case 51-1980: A 60-Year-Old Woman with a Cardiac Murmur and Abnormal Upper Extremities

Presentation of Case First admission. A 60-year-old woman was admitted to the hospital because of congenital heart disease. A heart murmur and skeletal anomalies were noted shortly after birth. Her early years were uneventful and free of symptoms. At the age of 39 years dyspnea developed, and atrial fibrillation was found; digitoxin was prescribed. Several years before admission exertional dyspnea increased in severity, and furosemide was prescribed. Five years before entry an echocardiogram demonstrated findings consistent with an atrial septal defect with right ventricular volume overload and pulmonary hypertension; a question of tricuspid prolapse was raised. Two years before.