A physical examination revealed a heart rate of 76 beats/min, a BP of 122/70 mm Hg, a respiratory rate of 10 breaths/min, and a room air oxygen saturation of 95% at rest. A general examination revealed an elderly woman who was comfortable with mild conjunctival pallor, without icterus, jugular venous distention, generalized lymphadenopathy, bruit, or goiter. Chest examination revealed a midline trachea, mild kyphosis, and no abnormal lung sounds. The cardiovascular examination revealed irregular heart sounds and a prosthetic valve click without murmurs or gallop. The abdomen was nontender without hepatosplenomegaly. The extremities were free of cyanosis or clubbing. The findings of a neurologic examination were unremarkable.