An Abnormal Echocardiogram and Telemetry Tracing in a Late Preterm Infant
| Autor: | Akshaya Vachharajani, Chaitanya Panchangam |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Abnormal echocardiogram Defibrillation medicine.medical_treatment Gestational Age medicine.disease_cause Ductus arteriosus Internal medicine Systolic heart murmur Left atrial enlargement medicine Humans Telemetry cardiovascular diseases business.industry Infant Newborn Infant Vascular ring medicine.disease medicine.anatomical_structure Pediatrics Perinatology and Child Health cardiovascular system Cardiology Supraventricular tachycardia business Nasal cannula Infant Premature |
| Zdroj: | NeoReviews. 22:e790-e794 |
| ISSN: | 1526-9906 |
| Popis: | A neonate is admitted to the NICU for a late preterm birth at 34 6/7 weeks’ gestation. The pregnancy was complicated by premature rupture of membranes and maternal intrapartum fever. The neonate’s initial course is unremarkable except for a requirement of supplemental oxygen by nasal cannula to maintain oxygen saturation above 94% and nasogastric feedings. On the 10th postnatal day, the neonate is noted to have episodic desaturations, with oxygen saturations decreasing to the low 80s. Physical examination findings are notable for a new grade 2/6 soft systolic heart murmur heard best at the apex. Clips of the infant’s echocardiogram are shown in Video 1 and Video 2. The cardiologist is concerned about left ventricular systolic dysfunction with significant regional wall motion abnormalities. The study also shows that the neonate has moderate mitral regurgitation, a large patent ductus arteriosus, and left atrial enlargement. The coronary artery origins are noted to be normal. The neonate is started on a milrinone infusion to manage the cardiac dysfunction. On the following day, he is noted to have multiple episodes of supraventricular tachycardia with heart rates up to 230 beats/min. Because of concerns about cardiac dysfunction, the cardiology team recommends starting digoxin for an antiarrhythmic effect. Two days later, the rhythm shown in Fig 1 is noted on the bedside monitor. Question 1. Based on this information, what is the likely diagnosis in this neonate? 1. Ebstein anomaly 2. Intrauterine viral infection 3. Total anomalous pulmonary venous return 4. Vascular ring 5. Ventricular septal defect Question 2. What is the most appropriate next management step for this neonate? 1. Administer digoxin-specific antibody fragments 2. Feel for a brachial or femoral pulse and if absent, perform emergent defibrillation 3. Feel for a brachial or femoral pulse and if present, perform … |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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