Abstract
A64-year-oldwomanof good past health presented to the emergency department with syncope. She had upper respiratory symptoms and dizziness followed byworsening exertional dyspnea and palpitation for 2 days. She then developed sudden lightheadedness and transient loss of consciousness. She denied any chest pain. Physical examination found normal blood pressure and pulse, oxygen saturation 94% in ambient air, elevated jugular venous pressure and bilateral ankle edema. A parasternal heave and a grade 2/6 pansystolic murmur at lower left sternal border were noted. Electrocardiography showed left axis deviation. Arterial blood gas confirmed hypoxia and uncompensated respiratory alkalosis. A chest X-ray was taken (Fig. 1).
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