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Difficulty: EasyPediatric Cardiovascular Disorders

Match each patient's clinical vignette with the most appropriate initial targeted intervention.

  • A 3-week-old premature infant (HR 165/min, SaO2 95%) presents with a widened pulse pressure, bounding peripheral pulses, and a continuous murmur at the left infraclavicular area.Administer a cyclooxygenase inhibitor (e.g., indomethacin)
  • A 2-day-old cyanotic neonate (HR 170/min, SaO2 75%) presents in shock with absent femoral pulses and no audible murmur, shortly after the physiologic closure of the ductus arteriosus.Initiate a prostaglandin E1 (alprostadil) infusion
  • A 6-month-old infant becomes agitated and profoundly cyanotic (SaO2 65%) while crying. Exam reveals a normal pulse pressure but a suddenly diminished harsh systolic murmur.Place the patient in a knee-to-chest position
  • A 2-year-old child presents with a 6-day history of 39.5°C fever, heart rate of 150/min, normal pulses, normal SaO2 (99%), and no murmurs, accompanied by a strawberry tongue and bilateral conjunctivitis.Administer intravenous immunoglobulin and high-dose aspirin
  • A 10-year-old child presents with fever (38.8°C), migrating joint pain, HR 110/min, normal SaO2 (98%), and a new holosystolic murmur at the apex following an untreated pharyngitis infection.Administer intramuscular penicillin G benzathine

Answer

Premature infant with PDA matches indomethacin; Neonate in shock with absent femoral pulses matches prostaglandin E1; Cyanotic infant with 'tet' spell matches knee-to-chest positioning; Toddler with Kawasaki disease matches IVIG and aspirin; Child with acute rheumatic fever matches penicillin.
Each pediatric cardiovascular condition requires a specific targeted intervention. Indomethacin is used to close a PDA, while Prostaglandin E1 is used to keep it open in ductal-dependent congenital heart disease. Tet spells are initially managed by increasing systemic vascular resistance via knee-to-chest positioning. Kawasaki disease requires IVIG and aspirin to prevent coronary aneurysms. Acute rheumatic fever necessitates penicillin to eradicate the triggering streptococcal infection.

Step-by-Step Solution

1
Analyze the first vignette: a premature infant with bounding pulses and a continuous murmur indicating a symptomatic PDA.
Matches with administration of a cyclooxygenase inhibitor to close the PDA.
Inhibiting prostaglandins facilitates ductal closure.
2
Analyze the second vignette: a cyanotic neonate in shock with absent femoral pulses indicating a ductal-dependent systemic circulation.
Matches with initiation of a prostaglandin E1 infusion to reopen the ductus arteriosus.
Exogenous prostaglandins prevent ductal closure, ensuring critical blood flow.
3
Analyze the third vignette: an agitated infant with severe cyanosis and a disappearing murmur indicating a tetralogy of Fallot hypercyanotic spell.
Matches with placing the patient in a knee-to-chest position to increase systemic vascular resistance.
This position kinks the femoral arteries, increasing systemic vascular resistance and forcing more blood through the pulmonary circulation.
4
Analyze the fourth vignette: a toddler with prolonged fever, conjunctivitis, and mucositis indicating Kawasaki disease.
Matches with administration of intravenous immunoglobulin and high-dose aspirin.
This combination dramatically reduces the risk of coronary artery aneurysms.
5
Analyze the fifth vignette: an older child with migrating arthritis and a new apical murmur indicating acute rheumatic fever.
Matches with administration of intramuscular penicillin G benzathine.
Eradication of group A Streptococcus is essential to prevent ongoing immune-mediated cardiac damage.

Key Concept

Targeted medical and positional interventions for common pediatric cardiovascular conditions.
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Topics

Pediatric Cardiovascular Disorders

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