Mild cough · wheezing · loud heart sounds · Dx?

Area of Science:

• Cardiology
• Pulmonology
• Diagnostic Imaging

Background:

• A 25-year-old US Navy sailor reported a 2-day history of mild cough.
• He denied systemic symptoms such as fever, chills, night sweats, angina, or dyspnea.
• The patient maintained full physical capacity for his occupation, with no significant past medical history or current medications.

Observation:

• Physical examination revealed mild wheezing in the upper lung fields.
• Unusually loud heart sounds were noted throughout the chest, audible with light stethoscope pressure.
• No murmurs, rubs, or gallops were detected on cardiac auscultation.

Findings:

• Electrocardiogram (EKG) showed normal sinus rhythm, right axis deviation with tall R-waves in V1 (suggestive of right ventricular hypertrophy), an incomplete right bundle branch block, and a crochetage sign.
• Chest x-ray demonstrated a normal-sized heart and dilated pulmonary vasculature, indicative of pulmonary hypertension.

Implications:

• The findings suggest a potential underlying condition causing pulmonary hypertension and secondary right ventricular changes.
• Early detection through physical exam findings and diagnostic imaging is crucial for managing cardiovascular conditions in active individuals.
• Further investigation is warranted to determine the etiology of the pulmonary hypertension and guide appropriate treatment strategies.