Wednesday, February 24, 2016

history of difficulty breathing during feeding-DrSudeepKC

A 2-week-old full-term infant is brought to the ED with a history of difficulty breathing during feeding.
Examination reveals a noncyanotic, tachypneic infant. The heart rate is 140/min, and you can easily hear a widely radiating systolic murmur.

Chest radiography shows cardiomegaly and pulmonary congestion. The child most likely has:
a. Patent ductus arteriosus.
b. Hypoplastic left ventricle.
c. Coarctation of the aorta.
d. Transposition of the great vessels.
e. Ventricular septal defect.


The answer is c. The first step in evaluating heart disease in the infant is to establish whether it is cyanotic or acyanotic. In the infant with heart failure, the diagnosis is aided by knowledge of the time course. Immediately after birth, congestive heart failure (CHF) is most often caused by noncardiac diseases such as hypoxia, hypoglycemia, hypocalcemia, acidosis, and sepsis.

Patent ductus arteriosus is the most common cause of CHF in premature infants, but hypoplastic left ventricle is the most common cause of CHF in the term infant’s first week. Coarctation commonly presents as acute CHF in the second week.

Transposition of the great vessels usually occurs in the first 3 days with cyanosis and failure. CHF due to a ventricular septal defect usually presents approximately 1 month after birth. After 3 months, CHF is most likely due to acquired diseases like myocarditis, anemia, and rheumatic
fever.

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