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Heart Failure in Congenital Heart Disease — RACP Paediatrics MCQ

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HardRespiratoryHeart Failure in Congenital Heart DiseaseRACP Paediatrics

A 6-week-old term infant presents with tachypnoea and oxygen saturations of 85% in room air. Chest X-ray shows cardiomegaly and increased pulmonary vascular markings. An echocardiogram confirms a large ventricular septal defect (VSD). Which sign would most strongly suggest the infant requires urgent surgical intervention?

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Correct answer: A — Hepatomegaly and a gallop rhythm

Hepatomegaly and gallop rhythm indicate decompensated heart failure requiring urgent intervention. While failure to thrive and diaphoresis during feeds also indicate haemodynamic compromise, hepatomegaly with gallop rhythm reflects fluid overload and myocardial dysfunction and is a more urgent surgical indication. A loud P2 may suggest pulmonary hypertension.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Heart Failure