หญิง 23 ปี มาด้วยเหนื่อยง่ายมากขึ้น ตรวจพบมี Systolic ejection murmur grade 4 at left upper sternal border คิดถึงสาเหตุจากอะไรมากที่สุดครับ
-A characteristic radiographic finding, even with mild valvular pulmonic stenosis (PS), is prominence of the main, right, or left pulmonary arteries caused by poststenotic dilatation.
-The intrapulmonary vasculature usually appears normal, even in severe PS.
-In critical PS, the pulmonary vasculature may appear decreased if significant right-to-left shunting occurs through a patent foramen ovale or atrial septal defect or if severe unilateral pulmonary artery branch obstruction is present.
-The overall heart size usually is normal unless RV failure or tricuspid regurgitation develops.
-A prominent right heart border suggesting right atrial enlargement may be present in as many as 50% of affected individuals.
-The degree of (right) ventricular hypertrophy on the ECG is largely correlated directly with the severity of PS.
-With mild PS, 50% of patients have a normal ECG tracing or only mild right-axis deviation.
-With moderately severe PS, right-axis deviation and increased R-wave amplitude in V1 are seen.
-Severe PS is associated with extreme right-axis deviation, a dominant R wave in AVR, and a prominent R wave (>20 mm) in V1.