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[Clinical Picture] Concentric circles in left atrium

A 51-year-old woman, who had a history of rheumatic heart disease, was admitted to hospital with a recent onset of reduced level of consciousness and right-sided weakness. Initial neurological examination was consistent with a right-sided hemiplegia. A CT scan of her head confirmed infarction of the left basal ganglia and left paraventricular regions of the brain. Examination of her cardiovascular system found her heart to be in atrial fibrillation with a ventricular rate of 110 beats per min. A diastolic murmur was heard on auscultation at the apex.