An unusual cause of dysphagia

A 74-year-old woman was referred for evaluation of dysphagia and weight loss. She had a history of dysphagia for solid foods, which had become worse over the past year. She had lost 5 kg in weight but her appetite was good. She suffered from mild heartburn without pain and her bowel movements were normal. Gastroscopy showed mild gastritis with a positive culture for Helicobacter pylori . A short course of triple antibiotic therapy and omeprazole was prescribed. Follow-up endoscopy appeared normal. Her heartburn improved but the dysphagia persisted. She had had a myocardial infarction 4 years earlier, complicated by acute mitral regurgitation due to papillary muscle rupture. This was repaired by urgent surgery. A post-operative echocardiogram showed slight left ventricular enlargement with decreased global function and moderate mitral regurgitation. She was treated with frusemide and digoxin and had minimal complaints of heart failure. She also …