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JAMA Cardiology Clinical Challenge
January 2017

A Woman With Progressive Dyspnea and Fatigue

Author Affiliations
  • 1North Shore Medical Center, Salem, Massachusetts
  • 2Interventional Cardiology, North Shore Medical Center, Salem, Massachusetts
  • 3Massachusetts General Hospital, Boston
JAMA Cardiol. 2017;2(1):101-102. doi:10.1001/jamacardio.2016.3689

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).

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