History about VSD

Patient was 24 years old in 2005.

In August 2005, at the time of her first pregnancy, patient had complete prenatal
check-up starting at 3rd month at the out-patient department of a hospital in
Lubang, Occidental Mindoro. Blood tests, urinalysis and ECG were done, as reported
by the patient, which showed normal results. Patient had occasional dyspnea, which
she attributed to her enlarged abdomen. The rest of her check-ups were
unremarkable. However, patient reported increased in blood pressure. Patient was
given with unrecalled antihypertensive. Patient was discharged after 3 days of
hospitalization. (PROM x unrecalled hours, patient was supposed to deliver at home
by a midwife, however, because of ROM, midwife advised patient to go to a hospital.
ROS was unremarkable). Patient was advised to monitor blood pressure for one
month, which eventually normalized, with antihypertensives being discontinued.
(Home medications were unrecalled).
For the next months, patient did not report any symptoms of dyspnea, cough or
edema. She observed that there was occasional shortness of breath and easy
fatigability when climbing their nine flight of stairs (patient said that this was not
present before first pregnancy). But most of the time, patient was still
asymptomatic during long walks.

A year after her first delivery, patient suddenly felt weak and tired after working and
cleaning their house. (parang gutom daw.. panu ba un???). No other associated
symptoms like dyspnea. Patient sought consult in a hospital in Lubang where 2D
echo was done for the first time which revealed VSD. Thyroid function test was also
evaluated which was normal. Patient was maintained on Centrum once a day which
she took with good compliance. Patient was asymptomatic in general.

Patient had another pregnancy in 2008, 2010 and 2014. Symptoms present was the
more pronounced dyspnea compared to her first pregnancy. 2D echo was also done
every time she was pregnant , which did not have any significant increase in
severity of her VSD.

ROS: (-) nocturnal cough, excessive weight gain, clubbing, cyanosis, neck vein
distention, palpitations
(+) bipedal edema in all pregnancy except first, which appears usually at 8 th or 9th
month

PE:
3cm Jugular vein
CXR?
ECG?
2D echo?
EF?

NYHA Class I

As for the GDM, it appeared in 2010 during her 3 rd pregnancy. No medications were
given as it was diet-controlled and returns to normal after delivery.