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Young woman with recurrent pregnancy loss
  1. Dinkar Bhasin,
  2. Gaurav Kumar Arora,
  3. Hermohander Singh Isser
  1. Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
  1. Correspondence to Dr Gaurav Kumar Arora, Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India; gaurav.arora89{at}

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Clinical introduction

A woman in her 30s was referred to our clinic as a part of the workup for recurrent pregnancy loss. She had not been evaluated for any cardiovascular illness previously. The patient had easy fatigability with a functional status of New York Heart Association class II. Cardiovascular examination revealed a parasternal heave, narrow splitting of the second heart sound with a loud pulmonary component and an early diastolic murmur of pulmonary regurgitation. An important clinical sign is shown in figure 1.

Figure 1

A clinical sign in pulmonary hypertension.


What is the diagnosis?

  1. Idiopathic pulmonary artery hypertension

  2. Patent ductus arteriosus with Eisenmenger syndrome

  3. Ventricular septal defect with Eisenmenger syndrome

  4. Atrial septal defect with severe pulmonary hypertension

Answer: B

The image shows differential cyanosis …

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  • Contributors All authors contributed to the conception, data collection, draft preparation and review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.