A 45yo lady has 10m hx of SOB. She is found to have irregularly irregular pulse and loud P2 with
fixed splitting and ejection systolic murmur in left 2nd ICS. What is the probable dx?
a. TOF
b. ASD
c. VSD
d. PDA
e. CoA
Q. 1. What is the key?
Q. 2. What is the diagnosis?
Ans. 1. The key is B. Atrial septal defect.
Ans. 2. Diagnosis is ASD with atrial fibrillation. [i) atrial fibrillation = irregularly irregular pulse. ii) ASD =
SOB, fixed splitting with loud P2, ESM in pulmonary area]. This picture is typical. One should not
misdiagnose SOB, ESM in pulmonary area and loud P2 as pulmonary hypertension (though in elderly this
can develop with ASD).