A 30-year-old woman was presented in ED with worsening shortness of breath with minimal exertion. Generally, she is fit and well but she started noticing such symptoms almost 8 months ago. She is a non-smoker and does not drink alcohol. She takes combined contraceptive pill but no other medication. She also complained of fatigue, palpitations, and feeling faint. There is no family history of venous thromboembolism or cardiorespiratory problems. Examination The woman has no chest pain, cough, swelling of ankles, loss of weight or fever.
Cardiovascular examination revealed a left parasternal heave, loud second heart sound with a pansystolic murmur loudest at the left sternal edge. Jugular venous pulse shows prominent V wave. Respiratory and abdominal examinations are unremarkable. The ECG is attached. Chest X-ray shows enlarged hilar vessels with an enlarged pulmonary artery shadow. Blood…
