Step II Girl with cyanosis

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Brown Boy With The Toys

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17 year old girl is under follow up at her GP for Asthma. Every time she gets an attack she has tachypnea, a waves on her JVP, and a loud P2. Whats the cause? And explanation

Drug effect
Congenital heart defect
Small thromboembolic clots due to pulmonary hypertenson