CC : A 2-month-old male infant was referred to the cardiology service due to cardiomegaly
PI : 5 days before admission the baby was brought in the emergency department because of choking during feeding. Physical examination revealed no dyspnea,O2 sat 97%, HR 148/ min, RR 48/min, PSM grade 3/6 at LLSB and increased P2 intensity. No adventitious sounds of both lungs were heard. Chest X-ray showed cardiomegaly. A pediatric resident was consulted and the impression of VSD was made. The patient was scheduled to the pediatric cardiology clinic for the next 5 days.
PH: Birth weight 2,200 gm. APGAR 10→10
Feeding: Absolutely breast feeding.
Family history: 7/7, Hill-tribe baby. Polished rice is the major food for mother. Mother also has history of numbness of hands and feet.
Physical Examination
GA: Alert, no dyspnea
VS: HR 152/min, RR 44/ min, BP 81/ 42 mmHg, O2 sat 98%
BW 4.2 KG (25th percentile), Ht 54 cm (< 3th percentile)
HEENT: no hoarseness
Chest: Lung- no adventitious sound
Heart: PSM grade 3/6 at LLSB, increased P2 intensity
Abdomen: no hepato-spenomegaly
Extremity: no edema
CNS: normal deep tendon reflex
Other: unremarkable
Laboratory Investigations
BUN = 3 mg/dl, Creatinine = 4 mg/dl, Na =136 mEq/L, K= 5.1, Cl =102, CO2CP =19
CBC: Hb=9.6 mg%, Hct = 27.2 vol%, WBC 6,900 mm3 ( N= 10.2, E= 2.8, B = 1.2, L= 69.8, M = 16) Platelet = 285,000 mm3, MCV 82
Fig1. CXR shows global cardiomegaly (without increased pulmonary blood flow)
Fig 2 EKG พบมี RVH จาก upright T in V1 และ inverted T wave in lead I, aVL,V5,6
