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A 59-year-old woman presented with a 6-month history of worsening fatigue and exertional dyspnoea. On physical examination, she had a mitral stenosis murmur, a loud P2, an irregular pulse and mild peripheral oedema. The electrocardiogram showed atrial fibrillation and the echocardiogram was notable for a fibro-calcified mitral valve, with severe restriction of leaflet mobility and an area of …
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