This is the chest radiograph of a woman in her late 80s with a history of hypertension, diabetes, heart failure, and atrial fibrillation (fig 1). She had been referred because of fever and worsening dyspnoea. Examination showed bilateral lung crackles, a grade 4/6 blowing high pitched holosystolic murmur of mitral regurgitation, and a grade 3/4 low pitched mid-diastolic rumbling murmur of mitral stenosis over the apex. The radiograph showed pulmonary congestion, and a heavily calcified mitral valve (arrow) and aortic ring. A subsequent echocardiogram showed severe mitral calcification, severe mitral regurgitation, moderate mitral stenosis, and mild aortic stenosis.bmj;384/mar21_10/e076186/F1F1f1Fig 1Non-rheumatic mitral calcification is a chronic, progressive process related to ageing and atherosclerosis. It is commonly associated with aortic calcification, diastolic dysfunction, and atrial fibrillation.1 Mitral calcification can cause severe dysfunction that might need surgical intervention when feasible. The patient was advised against valve replacement surgery because of her comorbidities and high…
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