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Difficulty: MediumPediatric Cardiovascular Disorders

Match each pediatric patient's clinical presentation with the most likely congenital cardiac anomaly.

  • A 4-year-old child with a widely split and fixed S2, and a grade 2/6 systolic ejection murmur at the left upper sternal border.Atrial septal defect
  • A 2-week-old premature infant with a continuous 'machine-like' murmur at the left infraclavicular area and bounding peripheral pulses.Patent ductus arteriosus
  • A 6-week-old infant with a harsh, grade 3/6 holosystolic murmur best heard at the left lower sternal border, and a palpable thrill.Ventricular septal defect
  • A 6-month-old infant with episodes of severe cyanosis during feeding, a prominent right ventricular impulse, and a harsh systolic ejection murmur.Tetralogy of Fallot
  • A 2-hour-old term neonate with profound cyanosis unresponsive to 100% oxygen and a narrow mediastinum on chest radiograph.Transposition of the great arteries

Answer

The accurate clinical alignments are: Atrial septal defect matches the fixed split S2; Patent ductus arteriosus matches the continuous machine-like murmur; Ventricular septal defect matches the holosystolic murmur; Tetralogy of Fallot matches the cyanotic feeding episodes with a systolic ejection murmur; and Transposition of the great arteries matches the neonatal cyanosis unresponsive to oxygen with a narrow mediastinum.
Each congenital heart defect has distinct pathophysiological consequences that manifest as specific, highly recognizable clinical signs. Mastering these patterns is essential for accurate clinical diagnosis in pediatric cardiology.

Step-by-Step Solution

1
Analyze the 4-year-old child's physical exam findings.
The fixed, widely split S2 is identified as pathognomonic for an atrial septal defect.
Constant increased right heart volume delays pulmonic valve closure regardless of the respiratory cycle.
2
Evaluate the premature infant's cardiac auscultation.
The continuous 'machine-like' murmur and bounding pulses confirm a patent ductus arteriosus.
Continuous blood flow from the higher-pressure aorta to the lower-pressure pulmonary artery occurs throughout the entire cardiac cycle.
3
Assess the 6-week-old infant's murmur.
A harsh holosystolic murmur at the left lower sternal border indicates a ventricular septal defect.
Blood flows from the left ventricle to the right ventricle consistently throughout systole.
4
Review the cyanotic 6-month-old infant's presentation.
Cyanosis during feeding (hypercyanotic spells) and a systolic ejection murmur point to Tetralogy of Fallot.
Right ventricular outflow tract obstruction causes the murmur, and episodic increased right-to-left shunting causes the cyanotic spells.
5
Interpret the newborn's refractory cyanosis and chest radiograph.
Cyanosis unresponsive to hyperoxia with a narrow mediastinum identifies Transposition of the great arteries.
Parallel circulations prevent oxygenated blood from reaching the systemic circulation, and the narrow mediastinum reflects an anterior-posterior positioning of the great vessels.

Key Concept

Identifying congenital heart defects based on classic physical examination and radiographic findings.
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Topics

Pediatric Cardiovascular Disorders

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