A 6-year-old child with a large, untreated systemic arteriovenous fistula presents with signs of heart failure, including tachypnea and poor growth. Echocardiography reveals a structurally normal heart but with an elevated cardiac output. This clinical picture is best described as which type of heart failure?
A 3-week-old infant with Down syndrome presents with tachypnea, poor feeding, and failure to thrive. Echocardiography confirms a complete atrioventricular septal defect. Compared to a child without Down syndrome, this infant is at higher risk for what early complication?
A 4-week-old infant with a large, non-restrictive ventricular septal defect was previously asymptomatic. The parents now report increased work of breathing. On auscultation, in addition to the known holosystolic murmur, you appreciate a new, low-pitched rumbling mid-diastolic murmur at the apex. What is the direct cause of this new apical diastolic murmur?
A 14-year-old, 6 years post-heart transplant for dilated cardiomyopathy, presents for routine follow-up. He has been intermittently non-compliant with his medications. An endomyocardial biopsy shows histologic damage, immunostaining positive for the complement component C4d, and macrophage expression of CD68, with minimal T-cell infiltration. Which of the following is the most accurate description of this process?
A 7-year-old with a history of a ventricular septal defect presents with a two-week history of daily low-grade fevers, fatigue, and myalgias. On examination, a new holosystolic murmur is heard. According to the modified Duke criteria, which of the following findings would be considered a major criterion for infective endocarditis?
A 4-day-old infant presents with marked cyanosis, respiratory distress, and a small heart with a dramatic perihilar pattern of pulmonary edema on chest radiograph. Auscultation reveals a single second heart sound and no significant murmur. Echocardiography is planned. Which diagnosis must be considered a surgical emergency where prostaglandin E1 infusion is unlikely to be effective?
A newborn diagnosed with tetralogy of Fallot is found to have a congenitally absent pulmonary valve. The infant develops severe respiratory distress, characterized by prominent wheezing and episodes of lobar collapse. What is the most direct pathophysiologic cause of this infant’s severe respiratory symptoms?
A 7-year-old girl presents for evaluation of severe hypertension. Laboratory studies reveal persistent hypokalemia and metabolic alkalosis, with suppressed plasma renin and aldosterone levels. Her father and paternal grandmother both had strokes before age 40. Which of the following monogenic hypertensive disorders best fits this clinical picture?
A 4-week-old infant with a large ventricular septal defect presents with tachypnea, diaphoresis during feeding, and poor weight gain. On examination, he is tachycardic and his liver edge is palpable 4 cm below the right costal margin. In an infant, what is the most reliable physical examination finding for assessing elevated systemic venous pressure?
An 15-year-old athlete collapses during a basketball game. He is resuscitated successfully. Subsequent evaluation with cardiac computed tomography reveals an anomalous origin of the left coronary artery arising from the right sinus of Valsalva, with the vessel passing between the aorta and the pulmonary artery. What is the most appropriate next step in management?
