Exertional dyspnoea in a 28-year-old woman

Heart. 2017 Nov;103(22):1779-1829. doi: 10.1136/heartjnl-2017-312174. Epub 2017 Sep 27.

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).

Questions: Which of the following would be most likely found during right heart catheterisation?Ratio of pulmonary to systemic blood flow (Qp:Qs) >1.5Pulmonary vascular resistance >3 Wood unitsRight atrial pressure >10mm HgPulmonary artery systolic pressure >45mm Hg E. Pulmonary artery diastolic pressure <10mm Hg.

Keywords: Congenital Heart Disease; Echocardiography; Pulmonic Valve Disease; Valve Disease Surgery.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Atrial Function, Right
  • Atrial Pressure
  • Blood Pressure
  • Cardiac Catheterization
  • Dyspnea / etiology*
  • Echocardiography, Doppler, Pulsed
  • Female
  • Heart Rate
  • Heart Valve Prosthesis Implantation / adverse effects*
  • Humans
  • Physical Exertion*
  • Predictive Value of Tests
  • Pulmonary Valve / physiopathology
  • Pulmonary Valve / surgery*
  • Pulmonary Valve Insufficiency / diagnosis*
  • Pulmonary Valve Insufficiency / etiology
  • Pulmonary Valve Insufficiency / physiopathology
  • Pulmonary Valve Stenosis / diagnosis
  • Pulmonary Valve Stenosis / physiopathology
  • Pulmonary Valve Stenosis / surgery*