A 13-year-old girl was admitted to the hospital, suffering from shortness of breath for the past 45 days, with progression for the last 5 days. The patient's mother mentioned an increase in the child’s abdominal girth and swelling around both ankles. History Afebrile, productive cough, chest pain, and hemoptysis The patient was found cyanosed at the time of birth. At 3 years of age, she underwent a surgical procedure for congenital cyanotic heart disease.
No history of repeated chest infections or childhood asthma. Examination Pulse rate: 48 beats/min Blood pressure: 96/66 mm Hg Cyanosis over the tongue, lips, fingertips, and toes was clubbed. Pitting ankle edema Engorged neck veins Breath sounds were vesicular without any rhonchi. Auscultation results showed a normal S1 and S2 with an early diastolic murmur over the pulmonary area and a soft pan systolic murmur over the lower-left…
