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A 2-month-old infant presents with poor weight gain, tachypnea, and a harsh systolic murmur on examination. Which congenital heart defect is MOST likely responsible for these findings?
In a patient with a history of cyanosis, clubbing of fingers, and the presence of a ‘boot-shaped’ heart on X-ray, which deficiency is likely responsible for the maintenance of PDA to ensure proper blood flow?
An echocardiogram reveals a non-restrictive ventricular septal defect and left ventricular hypertrophy in a child. Which physiological change is LEAST likely occurring?
A 5-year-old child with a known history of atrial septal defect presents with recurrent respiratory infections and failure to thrive. What is the BEST explanation for her presentation?
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In patients with coarctation of the aorta, what is a common finding on physical examination?
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Which diagnostic tool is most definitive for identifying the specific type of congenital heart disease?
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A newborn is diagnosed with a critical congenital heart defect. What is the FIRST management step that should be taken to stabilize the infant?
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Which of the following congenital heart defects is characterized by a right to left shunt and typically associated with cyanosis?
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In managing a patient with a ventricular septal defect, what is the primary complication that must be monitored for?
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In a case of a 3-year-old child who presents with dyspnea and fatigue, and has a family history of congenital heart disease, what is the critical component of the physical examination relevant for diagnosis?
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Study Notes
Congenital Heart Defects and Associated Findings
- Poor weight gain, tachypnea, and a harsh systolic murmur in a 2-month-old infant are strongly suggestive of ventricular septal defect (VSD).
- In a patient with cyanosis, clubbing of fingers, and a ‘boot-shaped’ heart on X-ray, a patent ductus arteriosus (PDA) is likely maintained due to prostaglandin E1 (PGE1) deficiency.
- Non-restrictive ventricular septal defect (VSD) and left ventricular hypertrophy in a child are associated with increased pulmonary blood flow, leading to pulmonary hypertension, but not decreased left ventricular preload.
- A 5-year-old child with atrial septal defect (ASD) presenting with recurrent respiratory infections and failure to thrive, suggests pulmonary hypertension due to increased pulmonary blood flow.
- Coarctation of the aorta commonly presents with hypertension in the upper extremities and hypotension in the lower extremities along with diminished or absent femoral pulses.
Congenital Heart Defects and Associated Findings
- Poor weight gain, tachypnea, and a harsh systolic murmur in a 2-month-old infant are strongly suggestive of ventricular septal defect (VSD). This defect allows blood to flow from the left ventricle to the right ventricle, leading to increased workload on the right side of the heart and pulmonary hypertension.
- Cyanosis, clubbing of fingers, and a 'boot-shaped' heart on X-ray are classic findings of tetralogy of Fallot. The deficiency of prostaglandins is likely responsible for maintaining the patency of the patent ductus arteriosus (PDA) in this case. The PDA provides an important pathway for blood flow from the aorta to the pulmonary artery, bypassing the obstructed right ventricular outflow tract.
- Non-restrictive ventricular septal defect (VSD) and left ventricular hypertrophy suggest increased left ventricular workload. Increased pulmonary vascular resistance is least likely to be occurring in this scenario. The non-restrictive VSD allows free flow from the left ventricle to the right ventricle, reducing pressure in the pulmonary arteries.
- Recurrent respiratory infections and failure to thrive in a 5-year-old with atrial septal defect (ASD) can be attributed to pulmonary hypertension and right heart strain. The ASD allows blood to flow from the left atrium to the right atrium, increasing blood volume in the right ventricle and pulmonary arteries, leading to strain on the right side of the heart and increased susceptibility to infections.
- Coarctation of the aorta is a narrowing of the aorta, often near the ductus arteriosus. A common finding on physical examination is a difference in blood pressure between the upper and lower extremities. The blood pressure will be higher in the arms than in the legs due to the narrowing of the aorta.
- Echocardiography is the most definitive diagnostic tool for identifying the specific type of congenital heart disease. It provides detailed images of the heart's chambers, valves, and blood flow patterns.
- Immediate stabilization of a newborn with a critical congenital heart defect should focus on maintaining adequate oxygenation and circulatory support. This may involve ventilation, administration of oxygen, and fluid resuscitation.
- Congenital heart defects characterized by right-to-left shunt and cyanosis include tetralogy of Fallot, transposition of the great arteries, and tricuspid atresia. These defects result in deoxygenated blood entering the systemic circulation, leading to cyanosis.
- The primary complication that must be monitored for in patients with VSD is heart failure. As the VSD allows blood to flow from the left ventricle to the right ventricle, the right ventricle becomes overloaded and can lead to heart failure.
- In a 3-year-old child presenting with dyspnea and fatigue with a family history of congenital heart disease, a thorough physical exam, including auscultation for heart murmurs, is critical for diagnosis. The presence of a murmur suggests a congenital heart defect, while other findings on physical exam like clubbing or cyanosis can provide further clues.
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Description
This quiz explores various congenital heart defects and their clinical presentations. It covers conditions such as ventricular septal defect (VSD), atrial septal defect (ASD), and coarctation of the aorta, along with their associated findings. Test your knowledge on these critical pediatric conditions and their implications.
