PMC8230164_01
(a) Phonocardiogram at the third left intercostal space showing S1, ejection click (EC), crescendo-decrescendo ejection systolic murmur from S1 to S2, single S2, and the presence of S3. (b) Twelve-lead surface electrocardiogram showing right-axis deviation with clockwise depolarization, peaked P waves in V1 and II, right ventricular hypertrophy, and rS complexes in precordial leads. (c) Chest X-ray anteroposterior view showing situs solitus as indicated by the gastric bubble on the left, levocardia, right atrial and right ventricular enlargement with decreased pulmonary blood flow, concave pulmonary bay (arrow), and left aortic arch
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F1
Phonocardiogram at the third left ICS confirmed these findings [Figure 1a]. Twelve-lead surface electrocardiogram showed right-axis deviation with clockwise depolarization, peaked P waves in leads V1 and II, RV hypertrophy, and rS complexes in precordial leads indicative of reduced pulmonary blood flow and underfilled left ventricle [Figure 1b]. Chest X-ray showed situs solitus, levocardia, RV upturned apex with decreased pulmonary blood flow, left aortic arch, right atrial enlargement, and concave pulmonary bay [Figure 1c].