Dyspnea in a pregnant 20-year-old woman with electrocardiographic right ventricular enlargement
D. Luke Glancy, MD, Sai K. Devarapalli, MD, Babu Makkena, MD, and Pramilla Subramaniam, MD
A 20-year-old woman, who was 2 months pregnant, came to the cardiology clinic complaining of exertional dyspnea of 6-months duration. Her chest was clear to auscultation, and the neck veins were modestly elevated. The second heart sound was single and loud. There was no cyanosis or clubbing. A midline sternal scar was noted and was described by the patient as the incision for a heart operation when she was 2 months old. An electrocardiogram showed sinus arrhythmia, marked right axis deviation (+135° as judged by equally positive QRS complexes in leads II and aVR), and right ventricular enlargement with a qR complex in lead V1 (Figure).
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