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Exertional dyspnoea in a 28-year-old woman
  1. Selma D. Carlson,
  2. Zachary L. Steinberg,
  3. Eric V. Krieger
  1. Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
  1. Correspondence to Dr Selma D. Carlson, Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA; selmad{at}uw.edu

Abstract

Clinical introduction A 28-year-old woman with a history of critical pulmonic stenosis, status postsurgical valvotomy and subsequent pulmonary valve replacement, presented to the cardiology clinic with 1 year of progressive exertional dyspnoea. She has a heart rate of 75 bpm and blood pressure of 110/55 mm Hg. Cardiac auscultation reveals a 1/6 systolic ejection murmur along the left sternum and an early 3/6 diastolic decrescendo murmur. A transthoracic echocardiogram is obtained (figure 1).

Figure 1

(A) Pulsed-wave Doppler tracing of transpulmonic flow. (B) Continuous-wave Doppler tracing of transtricuspid flow.

Questions Which of the following would be most likely found during right heart catheterisation?

  1. Ratio of pulmonary to systemic blood flow (Qp:Qs) >1.5

  2. Pulmonary vascular resistance >3 Wood units

  3. Right atrial pressure >10mm Hg

  4. Pulmonary artery systolic pressure >45mm Hg E. Pulmonary artery diastolic pressure <10mm Hg

Questions

  • Pulmonic Valve Disease
  • Congenital Heart Disease
  • Echocardiography
  • Valve Disease Surgery

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Footnotes

  • Contributors All authors participated in the writing and editing of the manuscript, as well as data collection.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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