Case Studies

Case 7: Heart murmur

You are asked to see a baby girl in the Emergency Department. She was born 8 weeks ago after an uncomplicated pregnancy. She has had increasing difficulty completing bottle feeds, sometimes taking up to 45 minutes per feed. On examination she looks breathless. She has a heart murmur.

• (a) What else would you look for on examination to establish whether the murmur is the cause of her symptoms?

  Show Answer

  Examine for signs of heart failure (tachypnoea, tachycardia, hepatomegaly, sweating). Respiratory causes such as pneumonia are excluded by the lack of crackles, cough or wheeze and the absence of fever.

• (b) What is the likely cardiac diagnosis?

  Show Answer

  The nature of the murmur and the breathlessness suggest a left-to-right shunt through a ventricular septal defect.

• (c) What advice would you give the child’s parents regarding dental treatment?

  Show Answer

  The left-to-right shunt across the ventricular septal defect means that the child is at risk of bacterial endocarditis. Although antibiotic prophylaxis is no longer recommended it is important that parents are advised to keep their child’s teeth and gums healthy, to visit a dentist regularly and to avoid body piercing when she is older.