An 18 year-old patient was referred by her mother by cognitive difficulties and emotional lability. Patient showing symptoms of depression, irritability, anhedonia, diminished energy but no changes in appetite or sleep. Past Medical History The patient was diagnosed with ADHD and learning disabilities at the age of 5 years and was treated with methylphenidate. The patient was also treated with trail doses of buspirone, risperidone and sertraline along with outpatient psychotherapy. On the physical exam a cardiac murmur was detected.
But, patient refused having any chest pain, dizziness or fainting. What examinations should be performed? What can be cause of heart murmur? What treatment approach is preferred?
