9th May 2025

An 18-year-old female presents to her GP due to increasing shortness of breath and fatigue.

An 18-year-old female presents to her GP due to increasing shortness of breath and fatigue. She reports that over the past several months, both legs have become swollen. She has tried elevating them, but this doesn’t always resolve the swelling. She has also been coughing more than usual. She has no known medical history but was born outside the UK and states she didn’t access healthcare until later in life. There is no report of unwell contacts or recent travel. 

On examination, her BP is 130/76 mmHg, HR 84 bpm and regular. There is a displacement of the left ventricular apex on palpation. A notable continuous murmur is heard loudest at the left infraclavicular area on auscultation of the heart. She has some crackles at the bases of both lungs and mild pitting oedema bilaterally to both shins. 

Given the most likely underlying diagnosis, which of the following would be the most appropriate treatment option?

Select the SINGLE most appropriate option from the list below. Select ONE option only.