A 63-year-old Mexican-American woman presents to the emergency department stating that for the past several nights she has had to sleep sitting up in a reclining chair because of difficulty breathing when lying in bed. She also reports that her legs have been swollen lately. She had no other complaints and no history of hypertension or diabetes. On physical examination, her height was 5 ft 3 in (1.5 m), weight 250 pounds (112.5 kg) and blood pressure 130/80 mm Hg. Rales were heard at the bases of her lungs; heart rate was 96 beats/minute, there was an S3 and S4 gallop and a grade 2/6 mid to late systolic mitral valve murmur. She had 2+ pretibial and ankle pitting edema. A lipid profile showed levels all within the American Heart Association/American College of Cardiology guidelines. An electrocardiogram...

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