A Case of........................?????
A 26 years old female presented with chief complaints of breathlessness , PND , pedal oedema . past H/O of fever ,sore throat &felting; polyarthritis at 12 yrs age. on examination pulse rate 104/min,irregularly irregular ,bp 110/70 mmHg & O2 saturation of 94% at room air
on CVS examination , raised JVP,with grade 2 parasternal pulsations,palpable P2 present ,on auscultation variable first heart sound with prolonged systolic murmur in mitral area. in pulmonary area second heart sound with wide fixed split and loud pulmonary component & pulmonary ejection systolic murmur
CBP &RFT; &LFT; - NORMAL
ECG shows ATRIAL FIBRILATION
Chest x-ray shows CARDIOMEGALY with straightening of left heart border
2 D Echo shows EF -49% , ASD with Left to Right shunt , severe MS ,moderate MR ,severe TR , moderate Pulmonary Arterial Hypertension with moderate RV dysfuntion
WHAT WOULD YOU THINK OF IT?????