7th March 2024

A 30-year-old man comes to the clinic with symptoms of fatigue, leg swelling, a sense of pulsation on his neck and abdominal fullness.

A 30-year-old man comes to the clinic with symptoms of fatigue, leg swelling, a sense of pulsation on his neck and abdominal fullness. Symptoms have been gradually progressive and began to occur over the last few months. The patient, who is an avid runner, reports increasing dyspnoea on exertion and the inability to exercise to his usual capacity. The patient’s medical history is notable for an intermittent murmur, which he was told was “innocent”. He underwent tonsillectomy and adenoidectomy at age 7 years for recurrent pharyngitis. There is no significant family. He does not smoke and rarely drinks alcohol. Clinical examination reveals a diastolic murmur. What is the likely diagnosis?

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