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Question category: Respiratory

A 44 year old smoker presents with increasing shortness of breath. She states she has fainted a couple of times on exertion. On examination there is a right ventricular heave and loud pulmonary second heart sound and an ECG shows right ventricular hypertrophy. Her chest is clear. A CXR is performed and is normal. What investigation should be performed for the definitive diagnosis?

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