Progressive Dyspnea

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Progressive Dyspnea and Pulmonary Hypertension in an Obese Patient with a New Prosthetic Mitral Valve

Case Presentation - August 2011:

Junyang Lou, MD, PhD

A 58 year old obese male is referred to Cleveland Clinic due to worsening fatigue, dyspnea on exertion and chest discomfort. He underwent mitral valve replacement one year prior for flail posterior mitral valve leaflet, receiving a #29 St. Jude EPIC Ô bioprothesis. His post-operative course was complicated by sternal wound infection and atrial fibrillation requiring AF ablation, from which he eventually recovered. He was finally feeling well five months after cardiac surgery and able to exercise daily. Over the last several months, however, he noticed progressive intense fatigue, SOB and neck and shoulder pressure. On several occasions he felt he might pass out. Pulmonary hypertension was diagnosed by his physicians and he elected to be referred to us for a second opinion. He denies fevers, chills or chest pain.

Past Medical History

The patient has long-standing obstructive sleep apnea (OSA) and has been using nocturnal CPAP therapy for the last 10 years. He also has coronary artery disease and received a drug-eluting stent to the left anterior descending coronary artery in 2007. He has remote smoking history and does not drink alcohol.

Reviewed: 11/13

Non-critical demographic information has been changed to protect the anonymity of the individual and no association with any actual patient is intended or should be inferred.

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