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8th March 2024
A 22-year-old male presents to the emergency department following recurrent syncope.
A 22-year-old male presents to the emergency department following recurrent syncope. He also describes feeling breathless on minimal exertion over the past six months. On examination, his heart rate is 76 beats per minute with a blood pressure of 146/84 mmHg. A loud P2 was heard but there was no murmur on cardiac auscultation. His laboratory investigations show:
| Haemoglobin | 14 | (13.5-17.7) g/dL |
| White Cell Count | 7 x 109 | (4-11) |
| Creatinine | 112 | (79-120) µmol/L |
| NT-proBNP | 900 | pg/ML |
Cardiac catheterisation with oxygen studies is performed:
| Site | O2 Saturation | Systolic Pressure |
|---|---|---|
| Right Atrium | 73% | – |
| Right Ventricle | 73% | – |
| Left Ventricle | 98% | – |
| Ascending Aorta | 98% | – |
| Descending Aorta | 93% | – |
| Pulmonary Artery | 90% | 90 mmHg |
What is the most likely diagnosis?
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