A 46-year-old woman with acute chest pain and shortness of breath was admitted to the emergency department. At the age of 41, the patient suffered dyspnea and edema in the lower limbs. She was admitted to a hospital and was diagnosed with severe pulmonary hypertension secondary to a patent ductus arteriosus. Because of high mortality of anesthesia, surgical intervention was not suggested. Thereafter, she was treated with a long-term medical regimen of diuretics and digoxin.
A physical examination revealed a regular heart rate of 90 beats/min, a respiratory rate of 25 breaths/min and blood pressure of 95/60 mmHg. She was afebrile, with elevated jugular venous pressure. The laboratory analyses revealed mild anemia (hemoglobin 98 g/L), hyponatremia (serum sodium 122 mmol/L), elevated blood urea nitrogen (10.97 mmol/L). Her ECG showed sinus rhythm, right atrial enlargement, biventricular…
