A 37-year-old laborer was presented to the outpatient clinic for fatigue associated with gradually increasing edema and abdominal distension for the last five months. The patient was physically fit and had no family history of cardiac diseases. General examination Vital signs were normal with: Blood pressure (BP): 110/80 mmHg Pulse rate: 110 bpm with irregular rhythms Heart rate (HR): 120 bpm with the presence of all peripheral pulses Respiratory rate: 22 breaths/min Temperature: 37.6°C Physical examination The jugular venous pressure of the patient was higher by 5 cm above the angle of Louis with prominent v wave and Y descent.
Bilateral pitting edema was present up to mid-thigh. After the auscultation of the lungs, crepitations on the right side were noted. Cardiac examination At the fourth left parasternal space, a grade 2/6, pansystolic murmur was noted, suggesting the presence of…
