The case

A 72-year-old woman who had undergone mechanical mitral-valve and aortic valve replacements 25 years earlier presented to the hospital with weakness and dark urine. Cardiac ultrasonography revealed normal biventricular function, no pericardial effusion, and a possible clot on the mitral valve. Diagnostic tests were performed.

Questions:

1. What diagnostic tests would you order in this case?
2. How would you approach the case?

Read the complete case report here

Malhotra R, et al. A 72-year-old woman with dark urine and weakness. N Engl J Med. 2020; 383:2066-2076.