Right ventricular failure in a young man

Right ventricular failure in a young manA 31-year-old man presented to the hospital for dyspnea that had progressively worsened over the previous 2 years.Initially, his dyspnea was present only on exertion, but during the past 2 months it had progressed to shortness of breath at rest.He also noted an intermittent dry cough.He reported no fevers, chills, chest pain, dizziness, syncopal episodes, hemoptysis, wheezing, or unintentional weight loss.The patient's past medical history included a reported but undetermined fungal infection 12 years earlier that had been treated with itraconazole.He had no signifi cant surgical or family history and did not take any medications on a regular basis.He did not smoke cigarettes, drink alcohol, or use illicit drugs.Physical examination revealed 2+ pitting edema in the bilateral lower extremities and crackles throughout bilateral lung fi elds.The cardiac examination was notable for a prominent second pulmonary heart sound, right ventricular heave, grade 3 of 6 holosystolic murmur most evident at the left sternal border, jugular venous distention, and hepatojugular refl ux.Initial laboratory values included elevated levels of troponin and B-type natriuretic peptide.Serum creatinine, lactate, and complete blood cell count were within normal range (Table 1).The patient's initial chest radiograph is shown in Figure 1.