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Congestive Heart Failure Lance K.
Shirai, MD, MS September Return to Table of Contents This a 6 week old female who presents to the emergency room with the 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 emesis. 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.
She is the product of a G3P2, full term, uncomplicated pregnancy. Delivery was unremarkable except for meconium stained fluid. She did well at delivery and in the nursery. Her pediatric follow-up has been poor.
She is a mildly cachetic, acyanotic infant who was pale, lethargic, and tachypneic, with mild to moderate subcostal and intercostal retractions.
HEENT exam is unremarkable. Neck is supple without lymphadenopathy. Her skin is clear with no rashes or other significant skin lesions. Her lungs have scattered crackles with slightly decreased aeration in the left lower lobe.
The precordium is mildly active. The S1 is normal and the S2 is prominent.
An S4 gallop is noted at the cardiac apex. There are no rubs or valve clicks. 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. Bowel sounds are hypoactive. 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.May 06, · I thought about this case this morning after reading a case study on Dr.
Smith’s ECG blog, which is an exceptionally good resource for learning about cardiac care. It regards the same type of scenario that happened to me all that many years ago.
Findings from this study are important for designing a multicenter trial of therapeutic hypothermia following in-hospital cardiac arrest in pediatric patients.
Importantly, the findings provide information about the number of patients available for study across the participating PECARN sites. Case Based Pediatrics For Medical Students and Residents with a Grade II/VI holosystolic murmur at the mid lower left sternal border with radiation to the cardiac apex.
The S1 is normal and the S2 is prominent. with arrhythmia induced heart failure will often respond well to anti-arrhythmic therapy and/or electrophysiology study and. implications of a discovered heart murmur in a child.2 First, as noted in this case study, most children with a heart murmur do not have significant heart disease.3,4 Unfortunately, diagnostic accuracy by primary care taking for pediatric heart murmur.
Occasionally, pa-. This pediatric simulation and unfolding case study takes place in the Nursing Learning Resource Center and is scheduled early in the Nursing Care of Children and Adolescents course.
The pediatric cardiovascular surgery patient: a case study. Hardingham K, Lerner D, Moloney-Harmon PA. The pediatric cardiovascular surgery patient has many needs, based not only on the complexity of the surgical procedure, but also on anatomic, physiologic, and emotional differences.