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A case of dyspnoea and visible neck pulsations
  1. Panakkal Jose Benny,
  2. Gopalan Nair Rajesh,
  3. Chakkanalil Govindan Sajeev
  1. Department of Cardiology, Government Medical College, Kozhikode, Kerala, India
  1. Correspondence to Dr Panakkal Jose Benny, Senior Resident, Department of Cardiology, Government Medical College, Kozhikode 673008, Kerala, India; bennyjose666{at}gmail.com

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Clinical introduction

A 48-year-old male patient with a history of New York Heart Association (NYHA) Class II dyspnoea for the last 2 years presented with acute onset breathlessness associated with orthopnoea and palpitations. The symptom aggravation was abrupt with simultaneous occurrence of both dyspnoea and palpitations. After medical stabilisation, the neck pulsations were as shown in online supplementary video 1.

Question

What is the most likely cardiac condition?

  1. Aortic regurgitation

  2. Congestive cardiac failure

  3. Tricuspid regurgitation

  4. Ventricular tachycardia

Answer: A

The major clue here is to find out whether it is an arterial pulsation or a venous pulsation. Typically, an elevated jugular …

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