Abstract
A 67-year-old woman reported having progressive shortness of breath over several months, three years after undergoing aortic-valve replacement for aortic insufficiency. The patient had migraine headaches for which she had received 2 mg of ergotamine tartrate daily for many years. On physical examination, her blood pressure was 170/95 mm Hg. She had elevated jugular venous pressure, and grade 2/6 systolic and diastolic murmurs were noted along the right sternal border. The results of laboratory analysis for 5-hydroxyindoleacetic acid were normal. Echocardiography showed a normal aortic-valve prosthesis and thickened mitral, pulmonary, and tricuspid valves with severe insufficiency. Cardiac catheterization revealed elevated . . .
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