Blue Light Special

This week I saw a 30 year old woman for "irregular periods". Upon further questioning, she actually has quite regular periods. That is until she missed her period last month. Contraception? "Condoms" (translation: no contraception). Sure enough her urine pregnancy test was positive, much to the shock of the patient and her husband (why the shock I'm not quite sure. She had a normal pregnancy and delivery just 2 years ago and surely must remember what was involved in the getting pregnant process). It was a happy shock, thankfully.

Of course, this is not all that remarkable. I see a newly pregnant woman almost once daily. More interesting was the fact that while we were waiting for the lab to run the pregnancy test, I found myself out of things to talk about. To pass the time I examined her (ok, also to ensure her amenorrhea wasn't anything more worrisome than pregnancy should the test turn out to be negative). I placed my stethoscope under her shirt on her chest and watched in all-too-familiar horror as my hand bounced up and down with the unnatural heave of her chest. She had an extremely loud, grating murmur, heard throughout her chest (almost heard without the stethoscope).

Inner monologue: Am I running a special on young, thin, Asian women with severe heart disease? Is there some sort of ark that I'm populating with all these two-by-two patients with matching diagnoses?

Upon further questioning, the patient did reveal that she has a "hole in her heart" that needed fixing a few years ago. She was supposed to consider this after her last pregnancy but hasn't seen the cardiologist since. I dug through her chart a bit more and found records from the cardiologist explaining her diagnosis in 2009 of (drum roll please) a very large atrial septal defect (4 cm!)with an enlarged right ventricle and pulmonary hypertension. The recommendation at that time was for closure post partum.

Glad to be keeping the cardiologists in business with my growing roster of young women that need heart surgery. Maybe we can go halfsies on the payment for surgery? Fine, I'll take a third.