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    CHINMAI

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    dburri
    case

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    CHINMAI

    Uploaded by

    dburri
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    case

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    case

    Copyright:

    © All Rights Reserved
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    Download as docx, pdf, or txt
    3 views2 pages

    CHINMAI

    Uploaded by

    dburri
    case

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    CCF CASE SCENARIO:

    A 6 week old female Infant who is a product of second degree consanguinous


    marriage with poor pediatric follow up was brought to casuality with chief
    complaints of lethargy, poor feeding, and respiratory distress. She was well until 2
    weeks prior to presentation when she developed a febrile illness with cough,
    rhinorrhea, and vomitings. She subsequently developed progressive respiratory
    distress. Her parents report that she sweats a lot on her forehead when feeding. Her
    parents have also noted her to be increasingly lethargic, with tachypnea, and
    retractions.

    Exam: VS T 36.8, RR 72, HR 160, BP 92/68,spo2-99%on RA

    She is a mildly cachexic, , lethargic, and tachypneic, with mild to moderate


    subcostal and intercostal retractions. Her skin is clear with no rashes or other
    significant skin lesions. On auscultation of chest slightly decreased aeration in the
    left lower lobe. The precordium is mildly active. Her heart is of regular rate and
    rhythm, with a pansystolic murmur at the mid lower left sternal border with
    radiation to the cardiac apex. The S1 is normal and the S2 is prominent. An S4
    gallop is noted at the cardiac apex. Her abdomen is soft, non-distended, and non-
    tender. The liver edge is palpable 3 to 4 cm below the right costal margin. There
    are no palpable masses or splenomegaly. Her extremities are symmetric and cool,
    with feeble peripheral pulses with no radial-femoral delay. The capillary refill is 4
    to 5 seconds (delayed).

    A chest x-ray shows moderate cardiomegaly with a moderate degree of pulmonary


    edema. There are no pleural effusions. A 12 lead electrocardiogram shows a sinus
    tachycardia, normal PR and QTc intervals, and a left axis deviation. Voltage
    evidence of biventricular hypertrophy is present. No significant Q-waves or ST
    segment changes are noted. An echocardiogram reveals a large perimembranous
    ventricular septal defect with non-restrictive left to right shunting. All cardiac
    chambers are dilated. Left ventricular contractility is at the lower range of normal.
    There is no pericardial effusion.

    Questions

    1. What is the most common congenital heart defect with a left to right shunt
    causing congestive heart failure in the pediatric age group?

    2. how do you approach a child with following medical scenario


    CCF CASE SCENARIO:

    3. What is the most likely age an infant with a large ventricular septal defect will
    begin manifesting symptoms of congestive heart failure?

    4. True/False. Administration of supplemental oxygen to a child with a large left to


    right shunt lesion will help improve the degree of congestive heart failure.

    5. What is the dominant mechanism with which infants and young children
    increase their cardiac output?

    7. The earliest sign of congestive heart failure on a chest X-ray is

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