A 45-year-old woman with a history of heart murmur detected in childhood. She is admitted to the emergency department for palpitations, easy fatigue and malleolar edema. Physical examination revealed absence of cyanosis. Oxygen saturation by pulse oximeter 97% BP 120/80 mmHg. Irregular heart rhythm at 100 bpm. Ejective systolic murmur (2/6) in pulmonary focus. 2nd unfolded noise, wide and fixed. No rales. Slight hepatomeglaia (2-3 cm). Slight malleolar edema. ECG: complete arrhythmia due to atrial fibrillation at 100 bpm. QRS +120º. Conduction disorder of the right bundle branch of the His bundle. What is its diagnostic orientation?
If he has a pediatric murmur, I'm thinking congenital. Hepatomegaly, malleolar edema and BRD, something that overloads the right heart. So we rule out aortic and mitral stenosis. A patent ductus would give cyanosis: ruled out. VSD or ASD? If I am told that he has AF, it is because the atria are of size XL, and a VSD does not produce atrial dilatation.
Ventricular septal defect.
Aortic stenosis.
Mitral stenosis.
Atrial septal defect.
Patent ductus arteriosus.
If I am told that he has AF, it is because the atria are of size XL, and a VSD does not produce atrial dilatation.
If he has a pediatric murmur, I'm thinking congenital. Hepatomegaly, malleolar edema and BRD, something that overloads the right heart. So we rule out aortic and mitral stenosis.
If he has a pediatric murmur, I'm thinking congenital. Hepatomegaly, malleolar edema and BRD, something that overloads the right heart. So we rule out aortic and mitral stenosis.
If I am told that he has AF, it is because the atria are of size XL, and a VSD does not produce atrial dilatation.
A patent ductus would give cyanosis: ruled out.