Abstract
A 64 year old male with end stage renal disease on hemodialysis was evaluated for dyspnea in the emergency room. An urgent transthoracic echocardiogram done for the physical finding of systolic ejection murmur revealed severe aortic stenosis with valve area of 0.98 cm2. Cardiac catheterization revealed non-obstructive coronary artery disease and moderate aortic stenosis. Patient developed an access site hematoma resulting in prolonged hospital stay. In the meanwhile, hemodialysis resulted in relief of his dyspnea. The present case brings into perspective the importance of physical exam for efficient and ‘do not harm’ principle of medicine.
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