| Abstrakt: |
Clinical History.—A boy aged 13 years and 9 months was referred to the University of New Mexico Medical Center because of increasing dyspnea on exertion, shortness of breath, orthopnea, and a 6.4-kg weight gain over a period of four days. He had been experiencing congestive heart failure for at least one year, but came to the hospital because of exacerbation of symptoms.Physical Examination.—The temperature was 37.3 C; the pulse rate, 112 beats per minute; respiratory rate, 28/min; and blood pressure, 120/70 mm Hg. Bilateral rales were heard. Examination of the heart revealed diffuse hyperactivity, sustained point of maximum intensity in the anterior axillary line with a right ventricular lift, as well as a grade 2/6 holosystolic murmur over the precordium, maximal at the lower left sternal border with radiation to the apex but not the axilla. The liver was down 4 cm. There was 4 + pitting edema |
