| Summary: | No abstract available. Article truncated after first page. A 71 year old woman presented with dyspnea since late 2013 and denies a prior history of dyspnea. She had a cardiac pacemaker placed in 2008 for sick sinus syndrome. Her physical exam was unremarkable and her SpO2 was 96% on room air. However, it decreased to 84% with exercise. Chest x-ray and pulmonary function testing were unremarkable (a DLco was unable to be performed). A transthoracic echocardiogram was performed (Figure 1). Which of the following best explains the patient's dyspnea and hypoxia? 1. Cardiac tamponade; 2. Decreased cardiac contractility; 3. Intracardiac shunt; 4. Mitral insufficiency; 5. Ventilation perfusion mismatch from COPD ...
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