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A 58-year-old woman presents with paroxysmal nocturnal dyspnea for two weeks, in a background worsening exertional dyspnea and vague chest pain for three months. No other symptoms are present.

Her surgical history is significant for two lower segment caesarean sections (LSCS) performed at the ages of 32 and 36 respectively. Her medical, drug, allergic, and family histories are all unremarkable. She does not smoke, only drinks socially, and does not use recreational drugs.

Her basic blood tests, including a complete blood count, serum electrolyte assay, and liver and renal profiles, are all within normal parameters.

Select Relevant Investigations
ESR + CRP

Performed

ESR: 5 mm/1h (<29)
CRP: <6 mg/L (<6)
ECG

Performed

The ECG is in sinus rhythm, with a rate of 76 bpm. No morphologic abnormalities are noted.
Echocardiography

Performed

The left atrium is enlarged, with a 5.8 cm x 3.0 cm elliptical, mobile, hyperechoic mass that prolapses into the left ventricle during diastole. Moderate mitral regurgitation is present. No other structural or valvular defects are noted. The ejection fraction is 58%.
Cardiac MRI

Performed

There is a 5.8 cm x 3.0 cm heterogeneous spherical pedunculated lesion within the left atrium, with a narrow point of attachment next to the fossa ovalis.

Select Relevant Management
Antibiotics
Anticoagulation
Surgical Resection
Mitral Valve Replacement