Abstract
A 56-year-old man was referred to the outpatient clinic of our cardiology department with a complaint of chest pain and dyspnea on exertion (New York Heart Association functional class II to III). According to his past medical history, he had visited a private hospital and had a diagnosis of idiopathic pulmonary arterial hypertension a few months earlier. He also had an episode of hoarseness due to left vocal cord palsy. On physical examination at our hospital, his blood pressure was 124/86 mm Hg, and his heart rate was 104 bpm. ECG showed sinus tachycardia, right atrial enlargement, and right ventricular hypertrophy (Figure 1). Initial transthoracic echocardiography revealed dilated right-sided chambers and right ventricular hypertrophy without any intracardiac or extracardiac …
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