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JAMA Cardiology Clinical Challenge
August 2018

A Young Man With Cardiomegaly and Edema

Author Affiliations
  • 1Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
JAMA Cardiol. 2018;3(8):777-778. doi:10.1001/jamacardio.2017.4439

A man in his mid-20s with no significant medical history presented with 18 months of progressive dyspnea, abdominal distention, and lower extremity edema. A chest radiograph showed significant cardiomegaly. A transthoracic echocardiogram (Figure 1) revealed a mildly dilated, hypertrophied right ventricle (RV) with normal function and significant right atrial (RA) enlargement (107 cm2). The tricuspid annulus was dilated (48 mm) with severe tricuspid regurgitation. There were no significant abnormalities of the left ventricle, left atrium, or pulmonic, mitral, and aortic valves. Invasive hemodynamic measures showed elevated RA pressure (14 mm Hg), but normal pulmonary artery pressure (16/11 mm Hg) and pulmonary capillary wedge pressure (7 mm Hg). Cardiac index calculated by the Fick method was 2.46 L/min/m2. Aggressive diuresis was initiated.