Case 39-1982 — Abrupt Onset of Dyspnea in a 59-Year-Old Man

Presentation of CaseA 59-year-old man was admitted to the hospital because of delirium and dyspnea.He was well until 10 months earlier, when there was the abrupt onset of dyspnea at rest as well as on exertion. He was admitted to another hospital, where an x-ray film of the chest revealed evidence of congestive heart failure. The pulmonary-capillary wedge pressure was 18 mm Hg and fell to 14 mm Hg after the administration of a diuretic medication, but repeated x-ray films of the chest revealed no change. An echocardiogram disclosed no evidence of valvular disease or an atrial myxoma. . . .