Echocardiographic "pseudo-IHSS" pattern in atrial septal defect.

‘J’he patient is a 30-year-old asymptomatic man with a heart murmur first discovered two months prior to his referral to the Mayo Clinic for cardiac evaluation. Physical examination revealed right ventricular lift, grade 2/6 ejection systolic murmur at the pulmonic area, and persistently split second heart sound. A mid-diastolic flow murmur was heard at the left lower sternal border. The roentgenogram of the chest revealed prominence of the main pulmonary artery segment and increased pulmonary vascular markings. An electrocardiogram revealed right ventricular conduction delay (rsR’ in lead V ) with a clockwise frontal plane QRS loop.