In the presence of constitutional symptoms, which condition is suggested by diastolic murmurs and transient ischemic attacks?

The presence of constitutional symptoms—such as fever, weight loss, or fatigue—combined with diastolic murmurs and transient ischemic attacks (TIAs) is highly suggestive of a cardiac myxoma. A cardiac myxoma is a benign tumor found in the heart, most commonly located in the left atrium. Its irregular shape and mobility can lead to turbulent blood flow, which is characterized by diastolic murmurs.

Additionally, parts of the tumor can dislodge, leading to embolization and subsequent transient ischemic attacks. These attacks occur when a piece of the tumor or a clot formed on it travels to the cerebral circulation, temporarily blocking blood flow to the brain, resulting in neurological symptoms.

The combination of heart murmurs, constitutional symptoms, and episodes of cerebral ischemia aligns well with the clinical picture of a cardiac myxoma, making it the most appropriate diagnosis in this scenario.