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[Clinical Picture] External left atrium compression by spinal osteophytes

A previously healthy 76-year-old woman was assessed preoperatively prior to hip arthroplasty. Cardiac examination was notable for a mid-diastolic murmur at the apex—appreciable only in the supine position. She had no signs or symptoms of heart failure. The patient’s N-terminal-pro-B-type natriuretic peptide blood concentration was normal (71 pg/mL). A transthoracic echocardiogram showed preserved biventricular systolic function, unimpaired diastolic relaxation, normal left atrial dimensions free of any intra-atrial septation, and no valvular abnormalities.