The nurse is assessing a child and hears a widely split S2, which is not affected by the respiratory pattern. The physician verifies the finding and orders a chest X-ray, which shows an enlarged heart

Question

An echocardiogram is ordered, which shows the defect. The finding by the nurse is a classic murmur found in which of the following cardiac defects? a. atrial septal defect c. patent ductus arteriosus (PDA)
b. tetralogy of Fallot d. transposition of the great arteries (TGA)

Answer 1

A

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A Correct. In atrial septal defect, the infant is generally asymptomatic. There is often a soft systolic murmur and more classically a widely split S2 unaffected by respiratory pattern. Chest X rays will usually demonstrate an increased heart size.
B Incorrect. In tetralogy of Fallot there is a characteristic systolic murmur resulting from the right ventricular outflow tract obstruction and is generally moderate in severity.
C Incorrect. The murmur of a PDA is often continuous, and a chest X ray is normal.
D Incorrect. These findings are not indicative of TGA. TGA should be suspected in an otherwise healthy newborn with acute cyanosis that is not responsive to oxygen. Chest X ray may be within normal limits or show a mildly enlarged right heart.