ECHO-an interesting case of VHD with LA CLOT

30/F presented with SOB GR IV NYHA
PALPITATIONS

CVS : apex L 5ics inside MCL tapping character DIASTOLIC THRILL at MA
MA : LOUD S1
GR IV MDM at MA low pitched best heard with BELL with
TA : gr III murmur HIGH pitched best heard with diaphragm at end inspiration.
AA : MUFFLED S2 ESM GR4 WITH THRILL best heard at end expiration in sitting position slightly leaning forwards radiating to carotids
EDM at NAA GR III
ECHO :
CALCIFICATIONS IN MV AND AV
SEV CRITICAL MS (MVA 0.59 cm2 BY PHT
0.8 cm2 by MV planimetry
SEV AS WIT AR
AvVmax >4m/s
SEV TR WITH SEV PAH the TR JET is biphasic with one central and one eccentric towards IAS
PASP >100MMHG
Large LA Clot