Cardiovascular Medicine 29

Question 29

A 28-year-old woman is evaluated after a 4-hour self-limited episode of palpitations. The symptoms occurred while at work yesterday. She has no history of cardiovascular disease and has no other cardiovascular symptoms. She is active without limitations. She is on no medications.

On physical examination, blood pressure is 110/70 mm Hg, pulse rate is 60/min and regular, and respiration rate is 15/min. BMI is 23. The estimated central venous pressure is elevated. The apical impulse is normal; there is a parasternal impulse present at the left sternal border, and a soft midsystolic murmur is heard at the second left intercostal space. Fixed splitting of the S2 is noted throughout the cardiac cycle. The remainder of the physical examination is normal.

Electrocardiogram is shown.

Which of the following is the most likely diagnosis?

A  Atrial septal defect

Bicuspid aortic valve with aortic stenosis

C  Congenital pulmonary valve stenosis

Mitral valve prolapse with mitral regurgitation

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