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A 69 year old woman with a history of obesity, hypertension, nicotine abuse, and periods of atrial flutter, was admitted with a New York Heart Association (NYHA) grade III dyspnoea. She did not complain of angina. Chest x ray revealed no signs of cardiomegaly or pulmonary oedema. The ECG showed a sinus rhythm with premature atrial complexes. Transoesophageal echocardiography …