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A 20 year old girl presents with exertional dyspnea and palpitations for 5 months.

There is no history of a cough, chest pain, orthopnea or paroxysmal nocturnal dyspnea.

Her medical and family histories are unremarkable.

Select Relevant Investigations
ECG

Performed

The ECG reveals P-pulmonale, right axis deviation, and a right bundle branch block.
Chest X-Ray

Performed

There is mild enlargement of the right side of the cardiac silhouette.
Echocardiogram

Performed

An osteum secondum atrial septal defect 1 cm in diameter is noted, with a left to right shunt. The ratio of pulmonary to systemic flow is approximately 1:1.6. The right atrium and ventricle are moderately dilated.
Coronary Angiogram

Performed

Coronary Angiography demonstrates a normal coronary vasculature.

Select Relevant Management
Endocarditis Prophylaxis
Antiarrythmic therapy
Device closure
Heart-lung Transplantation