A woman aged 44 years with no significant medical history presented with increasing exertional dyspnea and fatigue. Transthoracic echocardiography showed an atrial septal defect, and transesophageal echocardiography confirmed a 1.2-cm secundum atrial septal defect with bidirectional shunting without a clear superior rim. A computed tomographic (CT) pulmonary angiogram showed a dilated pulmonary artery consistent with pulmonary hypertension (Figure 1A).
Almaddah NK, Waldman HM, Toran A. A Woman With Progressive Dyspnea and Fatigue. JAMA Cardiol. 2017;2(1):101-102. doi:10.1001/jamacardio.2016.3689