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A 22-year-old woman presented with a 4-month history of dyspnoea on exertion and palpitations. She was in New York Heart Association class II at presentation. She had no history of fever, joint pains or rash. On examination, she had a grade II pansystolic murmur at the apex and an early diastolic murmur at the aortic area. Laboratory investigations revealed anti-streptolysin O titre of <200 units with normal erythrocyte …
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