Cardiac Dysfunction Case Study

Baby Einstein is a 2-month-old infant boy, born at term with no birth complications. He is admitted to the pediatric
unit with a diagnosis of Failure to Thrive (FTT). His weight on admission yesterday was 3.8 kg. During morning rounds,
baby Einstein’s mother tells the team that her son is easily fatigued during breastfeeding and never seems satisfied
after feeding. On assessment, you note that he appears to have a rather large thorax and otherwise has a weak, small
appearance.
His vital signs are:
BP: 75/45; P 185/min reg.; R 60/min, shallow, reg.; SpO2 98% in RA; T 37.5oC rectal

1. What do you think is happening?

Heart failure

2. What supporting data lead you to this hypothesis?

tachycardia, tachypnea, shallow breathing, fatigue, FTT, large thorax

3. What other assessments do you need to perform to complete a focused cardiac assessment on baby Einstein?

Inspection: color, nutritional assessment (growth chart)

Palpation: peripheral pulses
Auscultation: apical pulse (S3, S4/murmurs), abnormal sounds

Cardiology is contacted for a consult.

4. What diagnostic tests do you anticipate baby Einstein will have to undergo?

ECG, EKG, x-ray (size, shape, hypertrophy), electrolytes

5. How would you explain them to the mother?

Baby Einstein is diagnosed with a previously undetected ventricular septal defect (VSD).

6. Draw a sketch of this structural deformity in the heart. Where is the problem?

7. What complications could arise for baby Einstein in the near future? Explain with pathophysiology.

Hypoxemia, cyanosis
Since blood is shunting into the RV, it can cause a reversal of the gradient and that the deoxygenated
blood enters the systemic circulation which can lead to cyanosis, hypoxemia and eventually HF

8. How would you recognize these complications are occurring?