A 31-year-old woman presented to clinic with decreased exercise tolerance due to shortness of breath for the past 2 weeks. She has no chest pain but was experiencing heart palpitations a few times per week. She denies any significant medical history, takes only multivitamins, and mentions a childhood heart murmur that was never evaluated.
On examination, her blood pressure was 125/85 mm Hg, with a heart rate of 71/min and respiratory rate of 18/min. Physical examination revealed a fixed split S2 and a 2/6 systolic murmur at the left upper sternal border. An electrocardiogram demonstrated sinus rhythm with incomplete right bundle-branch block. A chest radiograph was obtained (Figure 1). Transthoracic echocardiography demonstrated an enlarged right atrium and right ventricle; results of contrast echocardiography were negative.
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Oh NA, Mayer JE. Decreased Exercise Tolerance in a Young Woman. JAMA. 2020;324(10):995–996. doi:10.1001/jama.2020.8415
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