A 23-Year-Old Primigravida at 29 Weeks Gestation Comes to the Emergency

A 23-year-old primigravida at 29 weeks gestation comes to the emergency department with sudden-onset severe shortness of breath.  She woke up today with a fluttering sensation in her chest, which progressed to significant dyspnea, dry cough, and an inability to lie flat.  Recently, the patient has had some exercise intolerance and tiredness, which she attributes to pregnancy.  Her medical history is significant for recurrent sore throat requiring tonsillectomy as a child.  She is a lifetime nonsmoker and does not use alcohol.  The patient's lifestyle is mostly sedentary.  She immigrated to the United States from India 5 years ago.  Her blood pressure is 110/60 mm Hg and pulse is 144/min.  The patient appears uncomfortable.  An ECG shows atrial fibrillation with rapid ventricular response.  Which of the following is the most likely diagnosis?

A) Aortic insufficiency
B) Constrictive pericarditis
C) Hypertrophic cardiomyopathy
D) Mitral stenosis
E) Myocardial infarction
F) Peripartum cardiomyopathy

Correct Answer:

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