Symptoms of Palpitations and Dyspnea With an Abnormal Ventricular Echocardiogram

Abstract

A 53-year-old housewife was seen because of a recent onset of palpitations and dyspnea on exertion; she had a history of heart murmur for 20 years. On physical examination, the patient was acyanotic and jugular venous pulses showed prominent and equal a and v waves; a left parasternal impulse was present. Auscultation revealed a pulmonary ejection sound followed by a midfrequency systolic ejection murmur at the second left intercostal space. Splitting of S 2 was wide and fixed, with accentuation of pulmonic closure. An S 3 was present at the fourth left intercostal space. Electrocardiogram showed atrial fibrillation and right axis deviation with right ventricular hypertrophy. A chest x-ray film revealed cardiomegaly and prominent pulmonary vascular markings with a prominent pulmonary artery. Her echocardiogram is shown in the Figure; the bold time lines at the top of the tracing are 0.2 second; the vertical dot intervals are 1.0 cm. What