The mother of a 10-month-old infant tells the nurse that she has noticed that her son becomes blue when he is crying and that the frequency of this is increasing. He is also not crawling yet
During the examination the nurse palpates a thrill at the left lower sternal border and auscultates a loud systolic murmur in the same area. What would be the most likely cause of these findings?
a.
Tetralogy of Fallot
b.
Atrial septal defect
c.
Patent ductus arteriosus
d.
Ventricular septal defect
ANS: A
The cause of these findings is tetralogy of Fallot. Its subjective findings include: (1) severe cyanosis, not in the first months of life but developing as the infant grows, and right ventricle outflow (i.e., pulmonic) stenosis that gets worse; (2) cyanosis with crying and exertion at first and then at rest; and (3) slowed development. Its objective findings include: (1) thrill palpable at the left lower sternal border; (2) the S1 is normal, the S2 has a loud A2, and the P2 is diminished or absent; and (3) the murmur is systolic, loud, and crescendo-decrescendo.
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