A two-month-old infant is hospitalized for repair of a ventricular septal defect. The infant’s admitting diagnosis is moderate congestive heart failure. What signs and symptoms would you expect to see in your assessment?
A.
Bradycardia, bounding pulses, cyanosis
B.
Overdiuresis, increased appetite, increased thirst
C.
Wheezing, pallor, capillary refill time < 2 seconds
D.
Tachypnea, cough, tachycardia
The Correct answer and Explanation is:
The correct answer is D. Tachypnea, cough, tachycardia.
Explanation:
In infants with moderate congestive heart failure (CHF), particularly those with a ventricular septal defect (VSD), several characteristic signs and symptoms emerge due to the heart’s inability to pump effectively. The primary problem in CHF is the backup of blood in the lungs and systemic circulation, leading to increased pressures and fluid accumulation.
- Tachypnea: This is an elevated respiratory rate, often observed in infants with CHF. Due to pulmonary congestion, the infant struggles to maintain adequate oxygenation, resulting in increased respiratory effort. The body attempts to compensate for reduced oxygen levels by breathing faster.
- Cough: Coughing can be a response to fluid accumulation in the lungs. In CHF, pulmonary congestion can lead to bronchial irritation and resultant cough, which may present as a wet or productive cough, particularly if there is significant fluid retention.
- Tachycardia: This refers to an increased heart rate, which is a compensatory mechanism when the heart is under stress. The body attempts to maintain cardiac output despite the heart’s reduced efficiency. In infants, tachycardia can be particularly pronounced, often exceeding 160 beats per minute.
The other options can be assessed briefly:
- A (Bradycardia, bounding pulses, cyanosis): Bradycardia is uncommon in CHF and may indicate other underlying issues. Bounding pulses can be seen in certain heart conditions but are not typical for moderate CHF. Cyanosis may occur but is more associated with severe cases or significant hypoxia.
- B (Overdiuresis, increased appetite, increased thirst): Overdiuresis is not expected in CHF; rather, fluid retention is common. Increased appetite and thirst would not typically be noted; rather, infants may exhibit poor feeding due to fatigue and respiratory distress.
- C (Wheezing, pallor, capillary refill time < 2 seconds): Wheezing is more characteristic of bronchospasm or asthma rather than CHF. Pallor can occur but is not a specific indicator, and capillary refill time < 2 seconds suggests good perfusion, which contradicts the state of CHF.
Overall, option D encapsulates the clinical picture typical in an infant with moderate congestive heart failure due to a ventricular septal defect.