Cardiology>>>>>Adult Congenital Heart Disease and Pregnancy
Question 9#

You are asked to review a 22-year-old male who has presented to the ED with sudden-onset chest pain and breathlessness. He has been diagnosed with a probable acute pulmonary embolism by the emergency team. They have asked for an echocardiogram to look for ‘right heart strain’ as he appears to be mildly compromised and they are considering thrombolysis if he decompensates. Auscultation of the heart sounds has revealed a loud continuous murmur and the CXR shows some pulmonary congestion.

What are you likely to see on echocardiography?

A) A dilated and hyperdynamic RV with evidence of acute TR secondary to raised pulmonary pressure
B) A jet of colour flow extending back into the RVOT from the pulmonary artery in the short-axis parasternal view
C) A jet of colour extending from the right coronary sinus into the right ventricle
D) A jet of colour across the apical interventircular septum in the four-chamber view
E) A flail mitral valve leaflet with severe mitral regurgitation

Correct Answer is C

Comment:

This case describes a young patient with sinus of Valsalva aneurysm rupture (acute symptoms, pulmonary congestion, and continuous murmur). Answer B describes a PDA which can be associated with a continuous murmur and endocarditis but not such an acute presentation. PE does not cause pulmonary congestion or a continuous murmur.