Presentation of CaseAn 86-year-old woman was admitted to the hospital because of dyspnea.Twenty-seven years previously a basal blowing systolic murmur was heard. Eleven years before admission a calcified coin lesion in the upper lobe of the right lung was demonstrated on an x-ray film of the chest. Isoniazid was taken sporadically; no change in the lesion was seen. Six years before entry the patient came to the hospital because of weight loss. A Grade 2 systolic murmur was heard and was maximal at the lower left sternal border. An x-ray film of the chest (Fig. 1) showed cardiac . . .