Case 10

M.D. is a 35-year-old Malay labourer who presented

with progressive shortness of breath on exertion 3/12.

There was no history of chest pain, palpitation, or

swelling of the legs. He sleeps with two pillows.

There was no history of acute rheumatic fever. He denies using illicit drugs. He was diagnosed to have a“murmur” in the heart in childhood.
Physical examination:

Afebrile

Orthopnea

Tachypnea

Polycythaemia

BP136/85 mmHg, PR 98/min regular, non-collapsing

JVP: elevated

Heart: Apex beat 6th ICS 3 cm lateral to MCL, forceful

Loud split 2nd HS

No L parasternal heave

EDM 1/6 in L sternal edge

Chest: NAD

Abdomen: Liver 2fb

CNS: NAD

What is your diagnosis?