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Paciente de 66 años con APP de HAS de larga evolución, con mal apego a tratamiento, inicia hace 3 meses con disnea de mayores esfuerzos, la cual ha sido progresiva hasta ser de mínimos esfuerzos, hace 3 días ya con disnea de esfuerzo y disnea paroxística nocturna, con edema de miembros pélvicos, por lo que acude al servicio de urgencias, donde toman el siguiente electrocardiograma Y Rx de tórax y

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