Pediatric Cardiovascular Disorders

Match each congenital heart defect to its most characteristic physical examination finding.

A 10-day-old male neonate is brought to the emergency department by his parents due to extreme lethargy, poor feeding, and rapid breathing over the past 12 hours. Physical examination reveals a mottled, pale infant with marked intercostal retractions and grunting. Vital signs are temperature 36.5°C (97.7°F), heart rate 185/min, respiratory rate 75/min, blood pressure 55/35 mm Hg in the right arm, and unobtainable in the lower extremities. Brachial pulses are 2+, but femoral pulses are absent. Capillary refill is 6 seconds. The infant is unresponsive to peripheral venous cannulation. Arrange the following interventions in the most appropriate sequential order for managing this patient's condition.

A 7-month-old boy is brought to the emergency department by his parents because of a sudden episode of deep blue discoloration of his lips and face. The parents report that he was crying vigorously when he suddenly became intensely cyanotic, tachypneic, and irritable. He has a known history of a congenital cardiac defect for which he is awaiting surgical repair. On arrival, the infant is agitated and visibly cyanotic. Vital signs show a heart rate of $165 \text{ /min}$, respiratory rate of $55 \text{ /min}$, and oxygen saturation of $68\%$ on room air. Auscultation reveals a harsh, crescendo-decrescendo systolic murmur over the left mid-to-upper sternal border. The physician immediately places the infant in a knee-chest position and administers $100\%$ oxygen via a non-rebreather mask, but the infant's agitation and cyanosis persist. Which of the following is the most appropriate next step in pharmacologic management?

A medical student is reviewing pediatric chest radiographs in the neonatal intensive care unit and outpatient cardiology clinic. Pair the following congenital cardiac anomalies with their classic, historically described radiographic appearances.

A 4-year-old boy is admitted to the hospital with a 7-day history of persistent fever measuring up to 39.5°C (103.1°F). Physical examination reveals bilateral bulbar conjunctival injection without exudate, brightly erythematous and cracked lips, a prominent 'strawberry' tongue, erythema and edema of the palms and soles, and a 2.5-cm right-sided cervical lymph node. A diagnosis of Kawasaki disease is made. Arrange the following therapeutic and follow-up steps in the most appropriate chronological order for the optimal management of this patient, from initial hospitalization to long-term preventive care.

A $2$-hour-old male neonate, born at $39$ weeks gestation to a mother with poorly controlled pregestational diabetes mellitus, is evaluated in the nursery for persistent cyanosis. The pregnancy was otherwise uncomplicated. Vital signs show a heart rate of $160$/min, respiratory rate of $65$/min, and blood pressure of $65/40$ mm Hg in the right arm and $68/42$ mm Hg in the left leg. Pulse oximetry reveals an oxygen saturation of $72\%$ on room air. Administration of $100\%$ oxygen via headbox for $15$ minutes fails to increase the oxygen saturation above $75\%$. Physical examination shows a deeply cyanotic infant with mild intercostal retractions. Cardiac auscultation reveals a normal first heart sound, a loud and single $S_2$, and no murmurs. The lungs are clear to auscultation bilaterally. Which of the following is the most appropriate next step in management?

Match each pediatric clinical presentation to the congenital cardiovascular anomaly most classically associated with the underlying condition.

During a routine health maintenance visit, a 9-year-old male is evaluated by a new family physician. His parents mention that he frequently stops to rest while playing outdoors with friends, complaining that his legs ache and feel weak. He has no history of significant illnesses and takes no daily medications. His vital signs show a temperature of 36.8°C (98.2°F), a heart rate of 82/min, and a respiratory rate of 18/min. Measurement of his blood pressure yields 146/92 mm Hg in the right upper extremity and 144/90 mm Hg in the left upper extremity. Upon further examination, simultaneous palpation reveals that his femoral pulses are significantly diminished in amplitude and temporally delayed compared to his brachial pulses. Auscultation of the heart demonstrates a regular rhythm without extra heart sounds, but a grade 2/6 systolic ejection murmur is audible over the left interscapular region. Which of the following findings is most likely to be present on further evaluation of this patient?