Snapshot A 26-year-old man presents to his cardiologist for exercise intolerance and blue discoloration of the lips and fingernails. He also reports occasionally coughing up blood. He reports having been diagnosed with a congenital heart defect when he was young but was lost to follow-up after moving cities. A Doppler echocardiogram shows a ventricular septal defect, right ventricular hypertrophy, and elevated pulmonary vascular resistance. Introduction Clinical definition login to view 1 more bullet Epidemiology login to view 2 more bullets Etiology login to view 3 more bullets Pathogenesis login to view 6 more bullets Prognosis login to view 3 more bullets Presentation Symptoms login to view 5 more bullets Physical exam login to view 9 more bullets Imaging Radiography login to view 9 more bullets Doppler echocardiography login to view 5 more bullets Studies Labs login to view 7 more bullets Electrocardiogram (ECG) login to view 2 more bullets Right heart catheterization login to view 4 more bullets Making the diagnosis login to view 1 more bullet Differential Interstitial lung disease causing pulmonary hypertension login to view 2 more bullets Treatment Management approach login to view 1 more bullet Conservative login to view 3 more bullets Medical login to view 13 more bullets Operative login to view 3 more bullets Complications Heart failure End-organ damage from hyperviscosity of erythrocytosis