Circulation Cardiovascular Case Series

A previously healthy 26-year-old man presented to a community hospital with a 1-week history of malaise, dyspnea, and cough productive of clear sputum. He also had intermittent lower abdominal pain for the preceding 5 days. He was otherwise healthy and not taking any medication. He was an ex-smoker with a 7-pack-year smoking history who quit 2 years ago, rarely drank alcohol, and denied using any recreational drug. On physical examination, he was afebrile, with a blood pressure of 110/75 mm Hg and a heart rate of 144 bpm. His respiratory rate was 17 breaths per minute, with an oxygen saturation of 99% on room air. On cardiovascular examination, there was no jugular venous distension, and the carotid pulse was of normal volume and contour. On precordial examination, the apical impulse was not palpable, and no obvious heaves or thrills were felt. Auscultation revealed a loud first heart sound and a normal second heart sound. There was a third heart sound (S3) audible over the lower sternal border and the apex. No additional sounds, rubs, or murmurs were heard. Abdominal examination revealed audible bowel sounds, with a soft and nontender abdomen and no organomegaly. There was no peripheral edema, and all peripheral pulses were palpable. Laboratory work, including complete blood count, electrolytes, and creatinine, was within the normal limits. A 12-lead ECG showed sinus tachycardia with minimal voltage criteria for left ventricular (LV) hypertrophy and no evidence of ischemia or infarction. A chest radiograph revealed cardiomegaly without any evidence of interstitial pulmonary edema or airspace disease.