A.T. , a 2 day old, was

A.T. , a 2 day old, was transferred to Riley Hospital. Chief complaint: ↑ RR and HR; ↑ pallor and diaphoresis with feeding; ↑ coughing, seems to get short of breath and easily tired with feeding – takes 60 minutes to consume 2 ounces of formula; ↓ number of wet diapers Physical exam: Length 50 cm (35th percentile); Weight 2670 grams (5th percentile) Vital Signs: HR 164 (normal 100-140); RR 68 (normal 30-60); BP 82/34 General: Irritable, ↑ napping, weak cry, hard to comfort, prefers elevated HOB position HEENT: Unremarkable, except facial stigmata of Down’s Syndrome Neck: Unremarkable, no JVD Lungs: Equal excursion and breath sounds bilaterally, fine crackles over lower lobes bilaterally, intercostal retractions with nasal flaring, nonproductive cough, O2 requirement ½ L NC Heart: Slightly hyperactive precordium, no arrhythmia, grade II/VI holosystolic murmur at lower LSB, grade III/VI systolic murmur at upper LMCL Peripheral vascular: skin – pale, cool and clammy (even when dressed only in a diaper), capillary refill less than 2 seconds, pulses +2 and equal bilaterally, no edema Abdomen: Soft, non-tender, non-distended, liver palpable @ 4 cm below RCM, bowel sounds x4 Extremities: MAE x4, but holds extremities in extension posture Neuro: Unremarkable for expected newborn reflexes Admission Diagnostics: EKG – normal sinus rhythm CXR – mild cardiomegaly with mildly increased pulmonary vascularity Echo – Large VSD; Q1. What are the significant findings in the chief complaint, admission assessment, and diagnostic findings? What is the clinical relevance of these findings? Q2. Explain the blood flow consequences of this congenital heart defect. How does this relate to the clinical presentation?

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