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Eisenmenger syndrome — SCE Respiratory MCQ

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ModeratePulmonary Vascular DiseaseEisenmenger syndromeSCE Respiratory

A 28-year-old man with unrepaired congenital heart disease has cyanosis, clubbing and exertional syncope. Oxygen saturation is 84% on air. Echocardiography shows a large ventricular septal defect with right-to-left shunting and severe pulmonary hypertension. What is the most likely diagnosis?

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Correct answer: E — Eisenmenger syndrome

Long-standing systemic-to-pulmonary shunt with severe pulmonary vascular disease and reversal to right-to-left shunting is Eisenmenger syndrome. Acute PE would not explain clubbing and congenital shunt physiology. COPD and OHS do not cause a large VSD with shunt reversal.

Reference: ESC/ERS Pulmonary Hypertension Guideline 2022; ESC Adult Congenital Heart Disease Guideline