Case presentation
A 46-year-old woman presented to our hospital with a history of a palpitations and exertional dyspnea for 3 months. She was incidentally found to have a heart murmur during cough treatment at local hospital in December 2019. However, she did not look for further inspection. Palpitations correlated with atrial flutter on Holter monitoring. She was referred to our hospital for further cardiac assessment and management.
Physical examination showed a blood pressure of 105/68 mmHg in left arm, a heart rate of 106 bpm, and an oxygen saturation of 96%–98% under room air between the upper and lower limbs. Her jugular venous pulsations were normal. Auscultation revealed that her lungs were clean. Cardiac examination found a right ventricular heave, but no thrills. Cardiac auscultation revealed normal heart sounds, with no added sounds. There was no hepatomegaly, peripheral clubbing, or edema.