Pectus excavatum can rarely result in clinically significant right ventricular (RV) compression, leading to impaired diastolic filling, reduced stroke volume, and secondary biventricular dysfunction involving both the right and left ventricles. We report a 19-year-old male who presented with progressive exertional dyspnea and was found to have severe pectus excavatum with a Haller index of 5.8 on cardiac magnetic resonance imaging and 3.6 on computed tomography. Multimodal cardiac evaluation demonstrated focal RV compression, moderate RV systolic dysfunction on cardiac MRI with a right ventricular ejection fraction (RVEF) of 31%, mild left ventricular (LV) systolic dysfunction with an ejection fraction of 44%-45%, and trivial mitral and tricuspid regurgitation. Spirometry was overall normal, without obstructive changes or exercise-associated bronchoconstriction, and electrocardiography revealed marked right-axis deviation. Coronary computed tomography angiography demonstrated normal coronary anatomy, while cardiac MRI showed no delayed gadolinium enhancement to suggest myocardial scar or infiltrative cardiomyopathy. In the absence of alternative clinical or imaging evidence for another cardiomyopathic process, the patient met morphologic and physiologic criteria for surgical repair and underwent minimally invasive correction with pectus bar placement without complication. At five-month follow-up, he reported resolution of dyspnea, although repeat postoperative cardiac imaging had not yet been performed. This case emphasizes the importance of recognizing extrinsic RV compression from pectus excavatum as a surgically correctable and likely reversible contributor to ventricular dysfunction and highlights the role of comprehensive imaging in guiding timely surgical intervention.

Pulmonary valve stenosis is a congenital heart disease that is usually diagnosed during childhood, while presentation in adulthood is uncommon and may lead to delayed diagnosis. We report the case of a 21-year-old patient with no significant medical history who presented with a six-month history of exertional dyspnea and constrictive chest pain. Electrocardiography showed right axis deviation with signs of right ventricular hypertrophy, and chest radiography revealed dilatation of the left pulmonary artery. Transthoracic echocardiography demonstrated severe valvular pulmonary stenosis with a peak velocity of 4.53 m/s and a maximum systolic gradient of 82.23 mmHg, associated with right ventricular hypertrophy and preserved systolic function, without evidence of pulmonary hypertension. Computed tomography pulmonary angiography confirmed focal post-stenotic dilatation of the left pulmonary artery. After a multidisciplinary discussion, balloon pulmonary valvuloplasty was recommended. This case highlights the importance of considering congenital pulmonary valve stenosis in young adults presenting with exertional symptoms and underscores the challenges of access to advanced interventional therapies in resource-limited settings.

An intrapulmonary shunt (IPS) occurs when blood bypasses oxygenation in the lungs, flowing directly from the right side of the heart to the left side without undergoing gas exchange. This condition is distinct from an intracardiac shunt, which involves an abnormal connection between the heart chambers or vessels, allowing atypical blood flow. In this report, we present the case of a 21-year-old man with a one-year history of persistent cough, nocturnal chest pain, nasal congestion with shortness of breath, and generalized abdominal pain. In the emergency department, his vital signs and physical examination were unremarkable. Electrocardiography (EKG) revealed sinus bradycardia with right-axis deviation and incomplete right bundle branch block pattern. Chest X-ray and routine laboratory investigations were normal. The patient was referred to cardiology for further evaluation of shortness of breath. A transthoracic echocardiogram (TTE) with a bubble study demonstrated a normal ejection fraction of 63% with no regional wall motion abnormalities. Agitated saline injected via the left antecubital vein revealed no bubbles in the left atrium during the first six cardiac cycles. However, after six cycles, a small number of bubbles appeared in the left atrium and left ventricle, indicative of an IPS. In this case report, we highlight a unique incidental finding of an IPS in a young man, emphasizing the importance of bubble study timing in distinguishing IPS from intracardiac shunts.

We present the ECG findings of a 49-year-old woman recorded in the emergency department, which reveal a wide-QRS, irregular rhythm. The ECG shows a broad terminal wave in the right precordial leads, along with a convex ST segment elevation, and is associated with a right axis deviation. While the initial presentation may appear complex, several diagnostic possibilities must be considered, as each could suggest a distinct management for this clinical case.