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Clinical Data: Progressive fatigue on exertion has been noted for two decades, despite operative intervention 10 years ago for the closing of interatrial communication, valvar and tricuspid annulus plastia, and plication of the right atrium. Currently, it is presented with fatigue for small efforts, lower limbs edema and in use of furosemide, hydrochlorothiazide, amiodarone and spironolactone.  Physical exam: Slightly dyspneic, cyanotic, diminished pulses. Clear jugular turgence at 30o. Weight: 61 kg. Height: 154 cm. Blood Pressure (BP): 100/65 mmHg. Heart Rate (HR): 80 bpm. Oxygen Saturation = 95%. The aorta was not palpable at suprasternal notch.  In precordium, ictus cordis was palpable diffusely and it had discrete systolic impulses in the left sternal border. The heart sounds were markedly hypophonetic and no cardiac murmur was auscultated. The liver was palpable 3 cm from the right costal margin, with discrete ascites. Lower limbs edema was moderate.

Case 6/2013 - 56 years old Woman with Ebstein Anomaly in Heart Failure