A 3-day-old full-term neonate develops severe heart failure. The physical exam is notable for a widened pulse pressure and a continuous murmur auscultated over the cranium. An echocardiogram reveals a structurally normal heart with biventricular dilation and poor function. What is the most likely underlying cause of this infant’s high-output heart failure?
A 17-year-old asymptomatic female is diagnosed with L-transposition of the great arteries (corrected transposition) with no associated defects after an abnormal ECG was noted during a pre-participation sports physical. What is the primary long-term concern for this patient, even in the absence of other structural anomalies?
A 2-day-old neonate presents with profound cyanosis and respiratory distress. A hyperoxia test is performed, and the arterial blood partial pressure of oxygen (PaO2) remains below 100 mm Hg after administration of 100% oxygen. Chest x-ray shows increased pulmonary vascular markings. This finding is most suggestive of which category of congenital heart disease?
A 10-year-old asymptomatic boy is found to have a blood pressure of 140/90 mmHg during a school screening. On physical examination, you note bounding pulses in his arms, a palpable delay between the radial and femoral pulses, and a systolic murmur heard in the left infrascapular area. Which additional cardiac anomaly is most commonly found in patients with this condition?
A 9-year-old with fulminant myocarditis is in cardiogenic shock in the intensive care unit with low cardiac output and poor peripheral perfusion despite adequate preload. He is started on a dobutamine infusion. If perfusion does not improve and systemic vascular resistance remains high, which intravenous agent would be most appropriate to add for its combined positive inotropic and peripheral vasodilatory effects?
A 10-year-old boy with a known history of Wolff-Parkinson-White (WPW) syndrome presents with palpitations. An ECG confirms supraventricular tachycardia. After failed vagal maneuvers, a long-acting agent is being considered for maintenance therapy. Which of the following agents is contraindicated in this patient?
A 1-day-old neonate born at term develops progressive, severe cyanosis. Physical examination is notable for a single, loud second heart sound (S2) and no significant murmur. An “egg-shaped heart” on a narrow mediastinum is seen on chest radiograph. What is the most likely diagnosis?
A 2-month-old infant with Down syndrome presents with tachypnea, diaphoresis with feeding, and failure to thrive. A cardiac exam reveals a hyperdynamic precordium and a holosystolic murmur. The electrocardiogram shows a mean QRS axis of -150 degrees. This patient’s cardiac condition results from a fundamental deficiency in which embryologic structure?
A 10-year-old with neurofibromatosis type 1 presents with sustained hypertension, intermittent headaches, and palpitations. He has no signs of renal disease on initial workup. Which condition, seen in approximately 5% of patients with his underlying genetic disorder, must be evaluated for as the cause of his hypertension?
A 9-year-old child is diagnosed with acute rheumatic fever with carditis. Examination reveals an apical holosystolic murmur. An echocardiogram confirms severe mitral insufficiency and an enlarged left ventricle. In addition to the holosystolic murmur, which auscultatory finding is most consistent with the acute phase of severe rheumatic mitral insufficiency?