Author(s): P. V. R. S. Subrahmanya Sarma1, B. Adilakshmi 2
PRESENTATION OF CASE
A female patient of age 48 years came with the complaints of dyspnoea on exertion, no history of orthopnoea or PND attacks. There is history of easy fatigability and mild abdominal distension, since past 3 months. On clinical examination, she is moderately built and nourished.
There was no pallor, cyanosis, clubbing, lymphadenopathy, oedema and icterus. Family history was not significant. She was conscious and coherent. Vitals were within the normal limits. Her BP being 120/76 mmHg. She was found to have an elevated JVP up to angle of the mandibule with a prominent "A" wave, and on palpation, there are no thrills or sounds palpable and on auscultation first heart sound and a normal split second heart sounds were heard with no added sounds or murmurs being heard and the presence of free fluid in the abdomen was confirmed. Hepatomegaly was also noticed. Clinically, she was thought to have right heart failure. Her ECG showed that she was in atrial fibrillation with controlled ventricular rate.
At this point of time, our differential diagnosis included ASD with PAH as she got the history of right heart failure features, but as there is no wide fixed split with the pulmonary vasculature being normal ASD was not considered. Other possibility is CRHD with tricuspid valvular involvement, but since there are no signs of other valvular involvement or the previous history of rheumatic fever in the past, this was not considered.