Knowledge Check: Clinical Presentation of Congenital Heart Disease in the First Week of Life – Congestive Heart Failure
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Question 1 of 5
1. Question
Ventricular septal defects (VSDs) lead to congestive heart failure through which of the following mechanisms?
Hint
4:57 – By one month of life, the pulmonary vascular resistance is low, so more blood is shunted from left to right, which causes a volume overload on the left side of the heart.
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Question 2 of 5
2. Question
Aortic stenosis leads to congestive heart failure through which of the following mechanisms?
Hint
5:56 – Aortic stenosis often presents during the first week of life when the heart has difficulty pumping past the left-sided stenotic lesion, leading to back-up of pressure in the left atrium and lungs.
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Question 3 of 5
3. Question
Which of the following represents the most common clinical presentation in neonates with severe (critical) pulmonary stenosis?
Hint
6:09 – Neonates with pulmonary stenosis have a severe right ventricular outflow tract obstruction, leading to elevated pressure in the right atrium, which allows deoxygenated blood to shunt from the right side of the heart to the left side and out to the body.
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Question 4 of 5
4. Question
A 7 day old girl comes to her routine newborn visit and is found to have the following vital signs: Temperature 36.8oC, heart rate 110 bpm, blood pressure 89/43 mmHg in the left leg, O2 saturation of 98% in the right arm. Which of the following right arm blood pressures would make you suspicious of coarctation of the aorta in this newborn?
Hint
8:04 – In coarctation of the aorta, pre-ductal systolic blood pressures (right arm) are often 20mmHg higher than post-ductal blood pressures (left leg).
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Question 5 of 5
5. Question
Which of the following represents one way to distinguish between aortic stenosis and hypoplastic left heart syndrome using ECG?
Hint
8:17 – Children with aortic stenosis often have left ventricular hypertrophy on ECG. Children with hypoplastic left heart do not have a left ventricle, and thus have right axis deviation and right ventricular hypertrophy, in addition to a lack of left-sided forces.
