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Question of the Week

Question: A 19 yo woman presents with complaints of DOE and mild fatigue. She has no significant medical history, does not use tobacco and takes no regular medications. On exam, her lungs are clear and cardiac exam reveals a II/VI systolic murmur at the 2nd left intercostal space, which varies with inspiration. What is the most likely diagnosis for this patient?

A. Atrial septal defect
B. Pulmonary stenosis
C. Bicuspid aortic valve
D. Ventricular septal defect
E. Hypertrophic obstructive cardiomyopathy

Answer Explained

This patient presents with a systolic murmur that varies with respiration. This makes it likely that the etiology is right sided, and given the location, pulmonary stenosis is more likely than tricuspid regurgitation. These right sided murmurs vary with respiration because filling of the right heart is influenced by changes in thoracic pressure.