Why Does She Have Dyspnea?

A 49-year-old female with a history of premature atrial and ventricular complexes and hypertension presented to the cardiology clinic for progressive dyspnea and exertional fatigue. On presentation, her heart rate was within normal limits, with a blood pressure of 130/80 mmHg, and room air saturations of 98%. Cardiac auscultation revealed a regular rhythm and a 2/6 systolic murmur at the lower left sternal border. An echocardiogram (Figure 1) revealed a flattened septum and dilation of the right atrium and ventricle. There was mild mitral valve prolapse with mild mitral regurgitation, moderate tricuspid regurgitation and an estimated right ventricular systolic pressure (RVSP) of less than ½ systemic. There was no evidence of an interatrial shunt in technically difficult, limited views.

Figure 1

Figure 1
Figure 1: 4 chamber view

Transesophageal echocardiogram (TEE) revealed a non-stenotic pulmonary valve with mild pulmonary insufficiency, a normal left ventricular ejection fraction, and a dilated right ventricle. The atrial septum was intact.

What is the cause of dyspnea and right ventricular dilatation in this patient?

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