Dyspnoea in a 36-year-old woman

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Clinical introduction

A 36-year-old African woman consulted because of crescendo dyspnoea New York Heart Association Functional Classification (NYHA) II–III and slight palpitations. There was no angina or coughing. Her medical and family history was unremarkable. Physical examination revealed a discrete systolic murmur, followed by a diastolic murmur (grade 3/6) along the left sternal border and at the apex. Blood pressure was 160/100 mm Hg. Lung auscultation and jugular venous pressure were normal. There were no signs of oedema. Blood tests demonstrated a slight anaemia (hemoglobin (Hb) 10.6 mg/dL), normal creatine kinase and troponin levels, as well as normal C reactive protein. N-terminal of the prohormone brain natriuretic peptide (NT-pro-BNP) was 107 ng/L. The ECG showed a normal sinus rhythm with non-specific T wave changes. Discrete cardiomegaly was seen on …

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