Match the following cardiac catheterization still-frame slide to it's respective diagnosis.
Hypertrophic cardiomyopathy. A left ventriculogram in right anterior oblique projection demonstrates a small ventricle with marked ventricular hypertrophy and narrow left ventricular outflow tract (LVOT).
Match the physical examination findings with the corresponding adult congenital heart disorder.
Right ventricular (RV) lift with a loud systolic ejection murmur along the left sternal border, with a single S2
TOF. On cardiac palpation and auscultation, patients with TOF demonstrate Right Ventricular lift (RV hypertrophy) and a systolic ejection murmur over the pulmonic region caused by Right Ventricular Outflow Tract (RVOT) obstruction. A soft, short systolic ejection murmur suggests severe obstruction. The intensity and severity of the ejection murmur are inversely related to the severity of RV obstruction. P2 is absent, and only the aortic component of S2 is audible.
Systolic ejection click, loud S1, holosystolic murmur, split S2 and hepatomegaly
Ebstein anomaly. Patients with Ebstein anomaly have a widely split S1 (reflecting delayed closure of the anterior tricuspid leaflet) and split S2 (delayed closure of the pulmonary valve due to associated right bundle branch block). The “sail sound” contributes to a loud S1 and reflects increased tension in the large mobile anterior leaflet as it reaches the limits of its systolic excursion. The systolic murmur of TR is typically grade 2/6 to 3/6 and heard loudest overlying the tricuspid area. Ejection clicks, opening snaps, and diastolic murmurs may be heard. Hepatomegaly caused by passive congestion and elevated RA pressure may be present.
Weak or delayed femoral arterial pulses, harsh systolic ejection murmur in the back, and a systolic ejection click in the aortic area.
Coarctation of the aorta. Patients with coarctation of the aorta have systolic hypertension and higher BP in their arms than in their legs, resulting in delayed femoral arterial pulses. Because many patients also have bicuspid aortic valve, a systolic ejection click is frequently present, and the aortic component of S2 is accentuated. A harsh systolic ejection murmur is audible along the left sternal border and radiates to the back, especially over the point of discrete coarctation.
Cyanosis, digital clubbing, loud P2 , and a variable Graham Steell murmur.
Eisenmenger syndrome. Patients with Eisenmenger syndrome demonstrate cyanosis and digital clubbing, the severity of which depends on the magnitude of right-to-left shunting. An RV lift and loud P2 caused by pulmonary hypertension are usually present. The murmur caused by ASD, VSD, or PDA is no longer present when Eisenmenger syndrome develops because left- and right-sided pressures have equalized. Many patients will have a tricuspid or pulmonary regurgitation murmur, or both.
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