Neurological examination was unremarkable. Other system examinations revealed no abnormalities. A cardiac examination revealed prosthetic aortic valve sound and 2/6 systolic murmur. On physical examination, the patient with an ongoing dizziness had blood pressure of 120/75 mmHg, heart rate of 41/min and body temperature of 36.6☌. In addition, she was receiving warfarin for AVR. The patient reported to have been receiving irbesartan (150 mg)+hydrochlorothiazide (12.5 mg) and amlodipine 10 mg for hypertension. She reported to have no other chronic diseases but hypertension for 15 years. The patient had undergone aortic valve replacement (AVR) due to calcific aortic valve stenosis 10 years ago. A 79-year old female patient was admitted to the emergency service with a 10-day history of complaints of dizziness, nausea, loss of appetite and syncope on the day of admission.
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