A 71-year-old female presents to the ED with a 2-day history of severe abdominal pain. Pain developed suddenly with no clear correlation to meals. Her symptoms were mild at first, becoming severe in the next 6 to 10 hours. She has nausea, but no vomiting or dysphagia. Her past medical history is significant for GERD, HFpEF, type 2 DM, and atrial fibrillation. She is afebrile. HR 70, BP 135/85 mm Hg. Cardiac examination reveals a 3/6 systolic murmur in L axilla and irregularly irregular heart rate. Her abdominal examination reveals mild tenderness in the mid-abdomen. Her stool is dark. Laboratory studies show Hgb 10.0 g/dL, WBC 17.5 103/mm3, Na 144 mEq/L, Cl 105 mEq/L, K 4.0 mEq/L, HCO3 20 mEq/L, Cr 1.1 mg/dL, A1c 12.6%, and INR 1.4. Medications are metoprolol, apixaban, insulin, and enalapril, but she has difficulty with medication adherence. What is the appropriate next step in evaluation?Ask StudybuddyGroup of answer choicesAndexanet alfaCT angiographyEGDColonoscopyGastric emptying study

A 24-year-old woman comes to the office due to pressure-like, substernal chest pain that occurs when she exercises.  The patient began noticing the pain approximately 6 months ago when she started to exercise to lose weight.  Prior to that, her lifestyle was largely sedentary.  She has no associated nausea, vomiting, diaphoresis, dyspnea, palpitations, or syncope.  The patient has no significant past medical history but was told as a child that she has a "murmur."  She has no significant family history of heart disease.  Blood pressure is 130/70 mm Hg on the right and 105/55 mm Hg on the left, and pulse is 72/min and regular.  BMI is 29 kg/m2.  A palpable thrill is present in the suprasternal notch.  There is a loud midsystolic murmur best heard at the first right intercostal space.  The lungs are clear to auscultation.  What is the most likely cause of this patient's chest pain?

A 38-year-old immigrant woman comes to the Emergency Department with right-sided weakness and slurring of her speech. Initial imaging and studies are obtained, and she is found to have suffered an ischemic stroke and is treated appropriately. When you go to examine her, she has an irregularly irregular pulse, and on cardiac examination she has an early diastolic high-pitched opening snap at the apex followed by a low-pitched diastolic rumbling murmur. Upon further discussion with the family, they indicate that she does not have any chronic medical problems and has not been to the doctor since she was a baby. She had frequent throat infections as a child, but these always resolved without treatment. She takes no medications and does not smoke or drink alcohol. The mechanism by which this condition developed is most similar to which of the following other conditions?Ask StudybuddyGroup of answer choicesGraves diseaseCystic fibrosisGuillain–Barré syndromeSarcoidosisInfective endocarditis

A 33-year-old woman presents with progressive shortness of breath. The symptoms started with exertion, but now she has dyspnea at rest. She has no previous medical problems, no family history of heart or lung disease, and she has never smoked. On examination, she has a holosystolic murmur and an S4, both heard along the left sternal border, and there is jugular venous distention. Her lungs are clear bilaterally with no wheezes or rales. Her lower extremities are nontender and symmetric in size. She is admitted and given supplemental oxygen. A chest x-ray shows mild dilatation of the pulmonary arteries, and the lung parenchyma is normal in appearance. What is the most likely diagnosis?

A 78-year-old male with a history of aortic stenosis with a mechanical aortic valve, hypertension, and type 2 diabetes presents to office for evaluation. He is doing well, except for some palpitations over the past few months. He does not have associated shortness of breath, syncope, or a history of falls. On physical examination, you note an irregularly irregular heart rhythm and a mechanical S2. Examination is otherwise normal. You obtain an ECG, which confirms the irregularly irregular arrhythmia. The patient has no history of bleeding and Hgb is normal. What is the recommended medication for prevention of thromboembolic events?Ask StudybuddyGroup of answer choicesWarfarinAspirinClopidogrelDabigatranApixaban

What is the probable explanation for her cardiac findings?