A young woman presents to the clinic. She has involuntary fast jerking movements of her face and all her limbs. They are uncoordinated and include facial grimacing and an unstable gait. She has a history of painful joints. On heart exam, you hear this:
Challenge: What's the diagnosis?
1. What is the heart murmur?
2. What is the movement disorder?
3. What is the pathophysiology of this disease?
4. What famous 19th century philosopher said the phrase in the title of today's case?
The mp3 audio file is linked under Fair Use. It can be freely downloaded from an American College of Cardiology website; this mp3 has been edited with the program Audacity. The specific source will be indicated in the solution to this case.