Case 41-1991

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Abstract
Presentation of Case First admission. A 76-year-old man was admitted to the hospital because of recurrent gastrointestinal bleeding.There was a history of an ostium secundum atrial septal defect that was repaired five years before admission, with placement of a large patch over the defect. Warfarin was administered for six months, without complication. Thereafter the patient was well until 18 months before entry, when a transient cerebral ischemic attack occurred during atrial fibrillation, and warfarin was resumed. An echocardiographic study showed borderline left ventricular hypertrophy and diffuse hypokinesis, with a left ventricular ejection fraction of 48 percent; the left . . .
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