Acute Pulmonary Edema in a Pregnant Patient

A 31-year-old woman was in generally good health, except for a heart murmur present since the age of 2 years. In the 14th week of her first pregnancy, she had had nausea and vomiting followed shortly thereafter with dizziness and a notable shortness of breath. Family history showed that a nephew was tall and lanky. Physical examination disclosed a pale dyspneic and diaphoretic patient who had a BP of 96/50 mm Hg and a heart rate of 120 beats per minute. Her height was 185 cm, arm span was 190 cm, and she had a high-arched palate. The fingers and toes were long, tapering, and spindly, with hyperextension and laxity of the joints. The neck veins were engorged. A systolic thrill was palpable over the suprasternal area radiating to both carotid arteries. A grade 2/6 crescendo-decrescendo midsystolic murmur was heard at the apex and along the left sternal border, and