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A 54year-old-male with a history on dilated cardiomyopathy and heart failure, now status post cardiac transplant 1 year ago, presents to the cardiologists office for a routine follow-up. The patient has been feeling well and has been compliant with all of his medications. You note that the patient is tachycardic to 110 in the office. He states he feels well and denies fevers. No coughing, chest discomfort, or shortness of breath reported. The remainder of his vital signs are normal. He is afebrile in the office. His cardiac exam is only notable for tachycardia. Mucous membranes are moist.