Multiple Cardiac Papillary Fibroelastomas
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A 76-year-old woman with a history of hypertension, diabetes mellitus, and permanent pacemaker implantation for symptomatic bradycardia two years previously presented with symptoms of fatigue, pedal swelling, intermittent chest discomfort, and exertional shortness of breath. She was hemodynamically stable on admission, saturating 95% on 4 L of oxygen via nasal cannula. Electrocardiography revealed atrial fibrillation with demand ventricular pacing, which was also new for this patient. Because her symptoms were consistent with heart failure, transthoracic echocardiography was performed and showed multiple mobile echodensities on the aortic valve at the left ventricular outflow tract level and on the pacemaker lead and a large mass in the left ventricle. Transesophageal echocardiography was performed the following day to better visualize these masses and again demonstrated multiple right- and left-sided intracardiac masses, with a large mass on the tricuspid valve....

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