Case 16 Gastroenterology

Chronic Diarrhea with heart problem

Work it one clue at a time. The diagnosis stays hidden until you reveal it.

Clue 1

A 55 y/o man presents for evaluation of chronic diarrhea. We walk into the room to meet him. We have an opportunity to make an “augenblick” diagnosis – one that can be made in the blink of an eye.

Clue 2

We listen to his heart to help confirm our hypothesis (best with headphones). There is a holosystolic murmur over the LLSB. Notice that the intensity of the murmur seems to vary in a regular cycle? It gets louder/quieter/louder/quieter. What is the significance of this?

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