A 45 year old lady has 10m history of SOB (shortness of breath). She is found to have irregularly irregular pulse and loud P2 with fixed splitting and ejection systolic murmur in left 2nd ICS. What is the probable diagnosis?

The key is B. ASD (atrial septal defect). [Diagnosis is ASD with atrial fibrillation. [i) atrial fibrillation =

irregularly irregular pulse. ii) ASD = SOB, fixed splitting with loud P2, ESM in pulmonary area]. This picture is typical. One should not misdiagnose SOB, ESM in pulmonary area and loud P2 as pulmonary

hypertension (though in elderly this can develop with ASD)].