1. Case 55 yr old presented with 3 weeks H/O palpitation and edema
Long standing H/O SOB -2yr
BP=108/70
HR-98/min A fib

2. Echo

10. Systemic VTI=14.5

11. LVOT diameter=2.4
What is QP/QS ratio?

12. Estimation of shunt flow ratio using Echo Doppler.
A common mistake by residents is to overcall the presence of ASD on 4 apical views. (Watch out: parallel beam may cause artifactual echo dropout of the septum – over call ASD). So the real best view is the substernal view: where intra-atrial septum is perpendicular to US beam.

13. A common mistake by residents is to overcall the presence of ASD on 4 apical views. (Watch out: parallel beam may cause artifactual echo dropout of the septum – over call ASD). So the real best view is the substernal view: where intra-atrial septum is perpendicular to US beam.

21. Cardiac catheterization
Left heart cath : Normal coronaries
Rt heart cath:
PVR=1.05 WU
O2 Saturations:
SVC= IVC= RA= RV= PA=92
PV, LA,LV =99.7
PAP=38/21/28
RVSP=38/8/10
RAP=11/11/10

22. What is the diagnosis
Now what to do