Patent Ductus Arteriosus: Clinical Case and Viva QnA
Clinical Case of Patent Ductus Arteriosus
A 2-month-old female infant is brought to the pediatric clinic for a routine checkup. The mother reports that the baby seems to tire easily during feeding and has been breathing faster than usual. On examination, the pediatrician notes the following:
- Weight: 3.8 kg (10th percentile for age)
- Respiratory rate: 65 breaths/min
- Heart rate: 160 beats/min
- Blood pressure: 85/40 mmHg with wide pulse pressure
- Oxygen saturation: 96% on room air
On auscultation, a grade 3/6 continuous "machinery" murmur is heard best at the left upper sternal border. The liver edge is palpable 2 cm below the right costal margin. Femoral pulses are bounding. Chest X-ray shows mild cardiomegaly and increased pulmonary vascular markings. Echocardiography confirms a moderate-sized patent ductus arteriosus with left-to-right shunting.
The infant is diagnosed with a hemodynamically significant PDA and is referred to a pediatric cardiologist for further management and consideration of closure.
5 Varieties of Presentation of Patent Ductus Arteriosus
- Asymptomatic Presentation: Small PDAs may be detected incidentally during routine physical examination when a heart murmur is heard. The child has normal growth and development with no symptoms.
- Premature Infant Presentation: In premature infants, PDA can present with respiratory distress, difficulty weaning from mechanical ventilation, metabolic acidosis, and signs of systemic hypoperfusion due to the "ductal steal" phenomenon.
- Congestive Heart Failure: Infants with moderate to large PDAs may present with poor feeding, tachypnea, diaphoresis during feeds, poor weight gain, and tachycardia. In severe cases, they may develop pulmonary edema.
- Eisenmenger Syndrome: In rare cases of large, unrepaired PDAs, patients may present later in childhood or adolescence with cyanosis, clubbing of fingers, and exercise intolerance due to the development of pulmonary hypertension and reversal of shunt direction.
- Acute Presentation with Complications: Rarely, PDA can present acutely with complications such as infective endarteritis (fever, new or changing murmur), aneurysm of the ductus (chest pain, hoarseness due to recurrent laryngeal nerve compression), or even rupture (severe chest pain, hypotension).
VSD Quiz for Medical Students & Professionals
This interactive quiz component covers essential concepts about Ventricular Septal Defects (VSD) in pediatric cardiology. It includes 25 high-yield viva questions with detailed answers
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