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A 15-year-old, previously healthy teenager who had fatigue, shortness of breath, vomiting, chest discomfort, lower extremity oedema and inability to lay flat for 3 weeks prior to her initial presentation. She was warm, well perfused with alternating strong and weak central as well as peripheral pulses and laterally displaced cardiac impulse. Her monitoring showed visual evidence of ‘pulsus alternans’—alternating low and high amplitude waveforms on the arterial waveform and plethysmography (figure 1). Her echocardiography showed severely …
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