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Eisenmenger Syndrome with Ventricular Septal Defect

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ECG CT scan


A 43 year old woman presenting with small volume hemoptysis, her third episode in 6 months. No sycope, no chest pain, no dypnea. She had multiple episodes of congestive heart failure as an infant, but improved in childhood. Her fingers were clubbed from earliest memory. She was told not to exercise vigorously as a child and counseled against pregnancy in adulthood. She can climb one flight of stairs but not further without resting. She has never had surgery or percutaneous cardiac interventions.

This petite woman had reddish-purple discoloration of her fingertips and palms, cheeks and nose. BP 103/66, HR 122, Temp 100.1, O2 saturation on room air 68%, increasing to 79% on 100% non-rebreather mask. Oropharynx deep red-purple. Back without scoliosus. Chest symmetric and clear. Neck veins 6 cm above the sternal angle of Louis at 60 degrees, with prominent 'a' wave. Prominent left and right ventricular impulses. Regular rhythm. Normal S1, persistently split S2 with loud P2 component. 2/6 systolic crescendo-decresendo murmur at left upper sternal border. _ long blowing high intensity diastolic murmur, best heard at the mid left sternal border. Severe clubbing of extremities. Normal creatinine, Hgb 16.8, Hct 50.5, platelets 86, MCV 92. Normal PT,PTT.

Clinical course...

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Keys to clinical management...

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February 24, 2000