A 45-year-old man presents with a history of shortness of breath, irregular heartbeat, and…

A 45-year-old man presents with a history of shortness of
breath, irregular heartbeat, and hemoptysis. He notes that over the past 2
weeks, he has become easily “winded” with minor activities. Also, he has
coughed up some flecks of blood on a few occasions. He has noted a fast
heartbeat and, on occasion, a pounding sensation in his chest. He gives a
history of being ill for several weeks after a severe sore throat in childhood.
On physical examination, his pulse rate is noted to be 120–130 bpm and his
rhythm is irregularly irregular. He has distended jugular venous pulses and
rales at the
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A 45-year-old man presents with a history of shortness of
breath, irregular heartbeat, and hemoptysis. He notes that over the past 2
weeks, he has become easily “winded” with minor activities. Also, he has
coughed up some flecks of blood on a few occasions. He has noted a fast
heartbeat and, on occasion, a pounding sensation in his chest. He gives a
history of being ill for several weeks after a severe sore throat in childhood.
On physical examination, his pulse rate is noted to be 120–130 bpm and his
rhythm is irregularly irregular. He has distended jugular venous pulses and
rales at the bases of both lung fields. On cardiac examination, there is an
irregular heartbeat as well as a soft diastolic decrescendo murmur, loudest at
the apex. An ECG shows atrial fibrillation as well as evidence of left atrial
enlargement.

Questions

A. What is the likely diagnosis in this patient, and what
are the elements in the history, physical examination, and ECG that support the
diagnosis?

B. What is the main pathophysiologic mechanism in this
condition, and how does it explain the irregular heartbeat, shortness of
breath, and hemoptysis?

C. What neurologic complication might this patient develop?

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