USMLE Step 2 Quiz
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CARDIOVASCULAR
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A 67-year-old man with a mechanical mitral valve prosthesis, placed 5 years ago for severe mitral regurgitation, presents to the emergency department with acute onset of severe dyspnea. His INR, checked last week, was 1.8. On examination, he is in respiratory distress. His blood pressure is 95/60 mm Hg and heart rate is 110/min. Auscultation reveals muffled prosthetic valve sounds and a new diastolic rumble. Lung auscultation reveals diffuse crackles.
What is the most likely diagnosis?
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