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A 59-year-old woman with a history of bilateral total hip replacements and a total knee replacement sees her physician for cough, exertional dyspnea, and foot swelling that had developed 2 weeks earlier while she was on vacation in Denmark. She received a diagnosis of pneumonia and “travel-related edema” and was treated with a course of antibiotics. Over the next week, the patient had progressive dyspnea, edema, and fatigue.
CT of the chest showed cardiomegaly and changes consistent with pulmonary edema; these findings prompted admission to her local hospital. Her jugular venous pressure was 13 cm of water, with normal respiratory variation. Cardiac examination revealed a regular rhythm, normal S1 and S2 sounds, an S3 gallop, and a grade 2/6 holosystolic murmur across the precordium. Cardiac catheterization ruled out coronary disease as the cause of new-onset heart failure. Treatment with furosemide, carvedilol, and lisinopril was initiated.
Despite some initial improvement in symptoms, six months after the onset of symptoms, she was having difficulty climbing one flight of stairs because of progressive dyspnea. Repeat echocardiography showed increased pericardial effusion.
As this case progressed, unusual causes of heart failure were considered. Additionally, the patient learned that her metal-on-metal hip implant was recalled.
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