# Systolic Ejection Murmur in a Case of Patent Ductus Arteriosus and Pulmonary Hypertension With Liver Cirrhosis

## TL;DR

A 38-year-old woman with liver cirrhosis had a systolic heart murmur leading to the diagnosis of a rare heart condition called patent ductus arteriosus.

## Contribution

This case highlights the atypical presentation of a systolic murmur in a PDA patient with liver cirrhosis and pulmonary hypertension.

## Key findings

- A systolic ejection murmur was detected in a patient with alcoholic liver cirrhosis.
- Right heart catheterization confirmed PDA with mild pulmonary hypertension.
- The case emphasizes the need to consider atypical murmurs in diagnosing PDA.

## Abstract

Patent ductus arteriosus (PDA) is a congenital anomaly characterized by a persistent connection between the descending aorta and the pulmonary artery. While patients with PDA typically present with a continuous murmur, atypical cases, such as those with systolic murmurs or no murmurs (although the exact mechanism remains unclear), pose diagnostic challenges. We report a case of a 38-year-old woman with alcoholic liver cirrhosis, referred for liver transplantation, in whom a systolic ejection murmur prompted further evaluation. Diagnostic imaging and right heart catheterization confirmed PDA with mild pulmonary hypertension, without evidence of Eisenmenger physiology. This case underscores the importance of recognizing atypical murmur patterns in the diagnosis of PDA to avoid misdiagnosis or delayed diagnosis.