Question

A 25-year-old woman with a history of a childhood murmur has chronic exertional dyspnea associated with intermittent chest pain, hemoptysis, and lightheadedness. She denies smoking, a history of travel, medication usage, fever, chills, cough, palpitations, abdominal pain, and peripheral edema. Her physical exam reveals central cyanosis, a right ventricular parasternal heave, JVD of 4 cm, and an accentuated P2 heart sound. A loud, harsh holosystolic murmur in the left third and fourth interspaces was present along the sternum, with a systolic thrill. An electrocardiogram noted right atrial enlargement, RVH, and right axis deviation. A bedside echocardiogram confirmed RVH, right atrial enlargement, and tricuspid regurgitation with a bidirectional ventricular shunt.

What health maintenance recommendations should be made to this patient?

1. The patient should avoid using oral contraceptives.
2. This patient should avoid foods containing iron.
3. Daily use of aspirin is recommended.
4. Regular, strenuous aerobic exercise should be strongly encouraged.
5. Routine CBC, EKG, and echocardiograms should not be made available.

Answer 1

The patient should avoid using oral contraceptives, should not avoid foods containing iron, regular use of aspirin is not recommended, strenuous aerobic exercise should be avoided, and regular monitoring with CBC, EKG, and echocardiograms is recommended.

Step-by-step explanation:

Based on the patient's history and physical exam findings, she is likely experiencing symptoms related to a congenital heart defect called Tetralogy of Fallot (TOF). TOF is characterized by four primary abnormalities in the heart, which include a ventricular septal defect (VSD), pulmonary stenosis, overriding aorta, and right ventricular hypertrophy.

There are several health maintenance recommendations that should be made to this patient:

1. The patient should avoid using oral contraceptives due to an increased risk of blood clots.
2. There is no need to avoid foods containing iron as iron deficiency is not a concern in this case.
3. Regular use of aspirin is not recommended unless otherwise indicated by a healthcare professional.
4. Strenuous aerobic exercise should be avoided due to the increased strain it may put on the heart.
5. Regular monitoring with CBC, EKG, and echocardiograms is recommended to assess the progression of the condition and guide treatment.