Dyspnea in a 63-Year-Old Who Had Heart Surgery as a Child

Sarah Blissett, MD, MHPE; Punag Divanji, MD; Harsh Agrawal, MD; Vaikom S. Mahadevan, MD; Elyse Foster, MD


December 09, 2019

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A 63-year-old man with repaired tetralogy of Fallot and repaired subaortic membrane presents with dyspnea upon exertion. He is not experiencing chest pain, pressure, or tightness. He does not report orthopnea, paroxysmal nocturnal dyspnea, palpitations, presyncope, or syncope.

Prior surgical procedures included valve-sparing repair of the pulmonic valve at 4 years of age, followed by insertion of a 26-mm pulmonary homograft, resection of a subaortic membrane, and addition of a mechanical aortic valve at 41 years of age. This was complicated by complete heart block, which necessitated implantation of a dual-chamber pacemaker.

He also has permanent atrial fibrillation, hypertension, and hyperlipidemia. Medications at the time of presentation include bisoprolol (5 mg daily), lisinopril (20 mg daily), spironolactone (50 mg daily), warfarin (4 mg daily), aspirin (81 mg daily), and atorvastatin (40 mg daily). He has no known allergies.

On social history, the patient states that he has never smoked tobacco or used illicit drugs. He has not recently been consuming alcohol. He has no family history of premature coronary artery disease.


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