Approach to congenital heart diseases (acyanotic) Quiz: Ace Your Exams
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A 7-day-old girl is brought to the emergency department by her parents for poor feeding, pallor, and mildly increased work of breathing. The infant was born via vaginal delivery at 39 weeks gestation. The pregnancy and delivery were uncomplicated. Apgar scores were 8 and 9. The baby had been feeding well until last night. Since then, she has been tired and uninterested in bottle feeding. Temperature is 36.8°C (98.4°F), pulse is 170/min, and respirations are 52/min. Right upper extremity blood pressure is 84/55 mmHg and right upper extremity oxygen saturation is 99%. Right lower extremity blood pressure is 64/42 mm Hg and right lower extremity oxygen saturation is 94%. On physical examination, the patient appears pale and irritable and has increased work of breathing, she is tachypneic and exhibits belly breathing. The anterior fontanelle is open and flat. A systolic murmur is heard and best appreciated at the left upper sternal border just below the left scapula. An S3 is present, and femoral pulses are faint. Lungs are clear to auscultation. There is no hepatosplenomegaly. Which of the following is the best next step in management?
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