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A 63-year-old woman presents with palpitations
  1. Frances A Tangherlini,
  2. Brian G Choi,
  3. Allen J Solomon
  1. Division of Cardiology, The George Washington University Hospital, Washington, DC, USA
  1. Correspondence to Allen J Solomon, Division of Cardiology, The George Washington University Medical Faculty Associates, 2150 Pennsylvania Avenue, NW, Suite 4-420, Washington, DC 20037, USA; asolomon{at}mfa.gwu.edu

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Clinical Introduction

A 63-year-old woman with a history of dwarfism presented with recurrent palpitations. She denied chest pain, dyspnoea or syncope. Her cardiac exam was notable for tachycardia at 188 bpm, hypotension (77/38) and no overt signs of heart failure. Cardiac markers were negative and her brain natriuretic peptide level was elevated at 687 pg/mL. An EKG revealed a left atrial tachycardia. She converted back to sinus rhythm after intravenous amiodarone. A chest X-ray demonstrated an enlarged cardiomediastinal silhouette. An initial transthoracic echocardiogram showed asymmetric septal hypertrophy, …

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