The Case of a 43 Year Old Man Who Presented With a Week of Diarrhea

A 43 year old man presents with one week of diarrhea. He has no significant past medical or surgical history but does not follow regularly with doctors. On arrival the patient is febrile to 103 degrees Fahrenheit, heart rate is 105 and blood pressure is 108 over 63. The sclera are ecteric; jugular venous pulsation is grossly elevated,. There is a systolic murmur audible at the upper sternal border. EKG shows atrial fibrillation with rapid ventricular response. Chest x-ray shows an enlarged cardiac silhouette and prominent pulmonary vasculature.