Approach to congenital heart diseases (acyanotic) Quiz: Ace Your Exams

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A 3-week-old boy is brought to the pediatrician for a weight check since he has not yet returned to his birth weight. Parents report that he has not been feeding well, and he tires quickly while bottle feeding. They have noticed mild increased work of breathing. He was born at 38 weeks 2 days gestation. The pregnancy was complicated by an abnormal prenatal ultrasound showing a moderate-large defect in the cardiac ventricular septum. Delivery was uncomplicated. Apgar scores were 9 and 9. Temperature is 37.1°C (98.8°F), pulse is 170/min, blood pressure is 100/65 mm Hg, respirations are 54/min, and oxygen saturation is 97%. On physical examination, the anterior fontanelle is open and flat. There is mild tachypnea, belly breathing, and intercostal retractions. Which of the following murmurs is most likely to be heard on examination?

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Systolic murmur radiating to the back

Systolic murmur with a widely fixed and split S2 heard best at the left upper sternal border

Holosystolic murmur heard best at the left lower sternal border

Systolic murmur heard best at the right upper sternal border, that is softer with Valsalva

Continuous machine-like murmur heard best at the left upper sternal border with radiation to the back