Case presentation A 77-year-old female presented to a general practitioner with hypertension, untreated hyperlipidemia, and hypothyroidism but no prior history of coronary artery disease (CAD) or angina symptoms. The patient was referred to a cardiologist for a treadmill exercise test secondary to the new onset of palpitations. She had no complaints of chest pain or pressure, shortness of breath, exertional dyspnea, or leg swelling. The patient had quit smoking 36 years ago and had no family history of early cardiovascular diseases.
A few years ago, she had a distant cardiac work-up that included a stress test and an echocardiogram, which were unremarkable. Vital signs Blood pressure: 140/78 mmHg Heart rate: 80 bpm Respiratory rate: 14 cycles/min Physical examination was unremarkable except for a systolic ejection murmur that was graded II/VI at the base. EKG was at baseline with normal…
