Clinical Abstract CK, 16 years old ,female , single , Catholic , Filipino , from Quezon City , consulted the clinic

for the 2nd time on Sept 3 , 2012 Chief complaint: difficulty in breathing The patient was diagnose with Congenital Heart Disease , Mitral Valve Prolapsed with mild mitral valve regurgitation 3 months prior to consult. One hour prior to consult after climbing 3 flights of stairs accompanied by palpitations and chest pain. She described the chest pain as substernal , squeezing , non- radiating and tolerable lasting for 10 minutes. The above symptoms persisted followed by difficulty of breathing and numbness of both hands which prompted her to consult this clinic . Impression : Congenital Heart Disease ,MVP with mild regurgitation, Poor compliance Past Medical History : July 2012- DOB -Nodado General Hospital Impression : MVP Thyroid Pathology OPD sent home , no medication August 5 ,2012 - DOB and numbness of the extremities Fatima University Clinic T/CHyperventilation Syndrome MVP etiology ? R/O Familial ( MVP syndrome )VS CHD ECG, Chest XR, and Echocardiography and color-doppler Cardio Referral symptomatic August 21, 2012 Consulted Cardiologist 2D echo with Doppler - done Medication Propranolol OPD -Follow up KC claimed that her father is hypertensive with medication while all her siblings are healthy.

She does not smoke nor drink alcoholic beverages. No food Preference OB-Gyne Menstrual History : unremarkable Review of System: (- ) Easy fatigability , (-)Orthopnea, (+) exertional dyspnea (+) SOB

Physical Examination : BP 100/60 mmHg , CR- 83/min RR- 18 Chest and Lungs : No retractions , No intercostals retractions , No wheezes ,No crackles Heart : no bulging ,dynamic precordium, PMI at 5th ICSMCL, Faint systolic murmur over the apex, full and equal pulses Extremities no Edema

Laboratory July 27, 2012 Chest X- Ray Lung are Clear Heart is not enlarged Bony structure are not remarkable Blood Chemistry FBS 81.1mg /dl BUN 8.81mg /dl Creatinine 0.5mg /dl Potassium 3.55 mmol Sodium 140.6 mmol CBC Hgb -133 Hct - .39 RBC Count- 4.17 WBC - 5.1 Segmenters- .62 Lymphocytes-.38

August 21, 2 dimensional echocardiography with doppler studies Concordant atrioventricular and ventriculo arterial connections Intact interarterial and interventricular septae The mitral valve leaflets are not 2012 thickened but the anterior mitral valve leaflets is prolapsing into the left atrium during systole producing mitral mitral regurgitation with regurgitant fraction of 7% and regurgitant jet of 29 mmHg Normal chamber sizes Good left ventricular systolic function with ejection fraction of 84 % No patent ductus arteriosus No coartation of the Aorta CONCLUSION: Congenital heart disease, mitral valve prolapsed with mild mitral regurgitation . .