Abstract
A 60-YEAR-OLD, 154 cm, 88 kg woman with essential hypertension, poorly controlled type II diabetes mellitus, and a previous kidney transplantation for end-stage renal disease resulting from diabetic nephropathy presented to a community hospital for evaluation of dyspnea and exercise intolerance. The physical examination was notable for an irregularly irregular rhythm and a grade II of VI holosystolic murmur best heard at the left lower sternal border. An electrocardiogram demonstrated new atrial fibrillation.
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