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A 25-year-old man presented to the emergency department with acute onset palpitation. He had a history of four to five similar episodes in the past 2 months, which had resolved on their own. ECG showed supraventricular tachycardia (SVT) with a rate of 170/min (figure 1). He was treated with intravenous adenosine which reverted the tachycardia. Transthoracic echocardiogram was attempted but an adequate window could not be obtained as the patient was obese. Only the spatial relationship of the two great vessels …