THÔNG TIN TÀI LIỆU
periostitis of several bones, and serologic testing is needed to confirm the diagnosis Cardiac Diseases (See Chapter 86 Cardiac Emergencies ) An infant with underlying congenital heart disease (CHD), including ventriculoseptal defect, valvular insufficiency, valvular stenosis, hypoplastic left heart syndrome (HLHS), or coarctation of the aorta, may present with shock or congestive heart failure and clinical findings similar to those of an infant with sepsis Symptoms may include tachycardia, tachypnea, pallor, duskiness, or mottling of the skin Cyanosis may not be present based on the direction of shunting and the patient’s hemoglobin level, which decreases physiologically to a nadir at about weeks of age There may be sweating, decreased pulses, and hypotension caused by poor perfusion A chronic history of poor growth and poor feeding may help differentiate heart disease from sepsis The presence of a cardiac murmur, a gallop rhythm, cyanosis unresponsive to 100% oxygen administration, hepatomegaly, neck vein distention, or peripheral edema may lead one to consider primary cardiac pathology Intercostal retractions and rales, rhonchi, or wheezing are nonspecific findings and may be present on chest examination in either heart failure or pneumonia HLHS or coarctation of the aorta may present with shock toward the end of the first or second week of life as the patent ductus arteriosus (PDA) closes A difference between upper- and lower-extremity blood pressures in a young baby suggests coarctation of the aorta, though pulse differences may not be detected if cardiac output is inadequate Normal femoral pulses not exclude a coarctation because the widened PDA provides flow to the descending aorta Check the dorsalis pedis or tibialis posterior pulses; these are more sensitive for detecting coarctation or low cardiac output A chest radiograph often shows cardiac enlargement and may show pulmonary vascular engorgement or interstitial pulmonary edema rather than lobar infiltrates (as in pneumonia) The electrocardiogram (ECG) may reveal abnormalities including right-axis deviation with right atrial and ventricular enlargement in HLHS, but can be nonspecific An echocardiogram is usually required to define anatomy and confirm specific diagnoses Rarely, an infant with anomalous or obstructed coronary arteries will develop myocardial infarction and appear septic These infants may have colicky behavior, dyspnea, cyanosis, vomiting, pallor, and other signs of heart failure They usually have cardiomegaly on chest radiograph, and the ECG usually shows T-wave inversion and deep Q waves in leads I and AVL Echocardiogram or cardiac catheterization is needed to confirm the diagnosis
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