A 92-year old woman was admitted to our internal medicine ward for dyspnea and asthenia. Oxygen saturation (SpO2) was 82%, blood pressure was 100/60mmHg, heart rate was 78bpm and body temperature was 36.1°C. Lung examination showed diffuse rales while heart auscultation bared a mild systolic murmur at the apex. Past medical history revealed only permanent atrial fibrillation treated with digoxin 0.125mg q.d. and warfarin with a target I.N.R. range of 2.0–3.0. She never smoked and used EtOH or drugs.
