A 35-year-old woman is evaluated for exertional dyspnea of 6 months' duration. She reports no other symptoms. Medical history is unremarkable, and she takes no medications. On physical examination, vital signs are normal, and oxygen saturation is 96%. An electrocardiogram demonstrates right axis deviation and incomplete right bundle branch block.

Which of the following is the most likely diagnosis?

1) Atrial septal defect
2) Bicuspid aortic valve with aortic stenosis
3) Congenital pulmonary stenosis
4) Mitral stenosis

Given the patient's symptoms and the electrocardiogram findings, the most likely diagnosis is an Atrial Septal Defect, a congenital heart defect which can result in a mixture of oxygen-rich and oxygen-poor blood in the heart.

Explanation:

In examining the case of a 35-year-old woman with exertional dyspnea, an electrocardiogram indicating right axis deviation, and incomplete right bundle branch block, the most likely diagnosis would be an Atrial Septal Defect (ASD). ASD is a congenital disorder that can go undiagnosed until adulthood and fits the patient’s symptomology and clinical presentation more closely than the other options provided.

An Atrial Septal Defect is a hole in the wall between the two upper chambers (atria) of the heart. This leads to the mixing of oxygen-rich and oxygen-poor blood, which can cause symptoms such as exertional dyspnea, displayed by the patient. The electrocardiogram findings of right axis deviation and incomplete right bundle branch block are also consistent with an ASD due to the increased flow of blood through the right side of the heart.

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