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Patient Ductus Arteriosus (PDA) in a Pediatric Patient in Sub-Saharan Africa.

Patient Ductus Arteriosus (PDA) in a Pediatric Patient in Sub-Saharan Africa.

Patient details
Patient details.
J, a 2-month-old male infant from a rural village in Uganda.
Patient case fields
Presenting Complaint

 J’s mother brought him to the district health center with concerns about persistent fast breathing, difficulty feeding, and poor weight gain. She also noticed that he sweats excessively during breastfeeding and gets tired quickly.

History

J was born at 35 weeks gestation after a complicated pregnancy with maternal malaria. He was delivered at a local clinic and had no immediate complications, but since birth, he has struggled to gain weight and has frequent bouts of respiratory infections. J is the second child in his family, with no family history of congenital heart disease.

Examination

Vitals: Heart rate 160 bpm, respiratory rate 60 breaths per minute, oxygen saturation 95% on room air.

Growth: Weight at the 5th percentile for his age.

Cardiac Exam: Continuous "machine-like" murmur heard below the left clavicle.

Respiratory Exam: Mild intercostal retractions with clear lung fields.

Other Systems: No cyanosis, normal pulses in all extremities, and no hepatomegaly.

Investigations

Chest X-ray revealed cardiomegaly with increased pulmonary vascular markings.

An echocardiogram confirmed a moderate-size patent ductus arteriosus (PDA) with left-to-right shunting.

Diagnosis: J was diagnosed with a moderate PDA, contributing to his symptoms of heart failure and respiratory distress.

Management Plan
  1. Medical Management: J was started on diuretics to manage heart failure symptoms and advised on optimizing his nutrition to support growth.
  2. Interventional Referral: Given the moderate size of the PDA, J was referred to a tertiary hospital for possible closure via catheter-based intervention, though there were concerns about access to the procedure due to resource limitations.
  3. Follow-up and Family Education: The family was counselled on the importance of follow-up visits to monitor J’s condition and prevent complications like pulmonary hypertension.
Prognosis

If J is able to undergo timely PDA closure, his prognosis is favourable. However, delays in treatment due to limited access to specialized care could lead to worsening heart failure or pulmonary hypertension.

Discussion
No data was found
Questions
1. What is the most likely diagnosis based on J’s symptoms and clinical findings?

a). Ventricular Septal Defect (VSD)

b). Atrial Septal Defect (ASD)

c). Patent Ductus Arteriosus (PDA)

d). Tetralogy of Fallot

2. Which clinical feature is most characteristic of a Patent Ductus Arteriosus (PDA)?

a). A pansystolic murmur at the left lower sternal border

b). A continuous "machine-like" murmur below the left clavicle

c). Cyanosis and clubbing

d). Loud S1 and fixed splitting of S2

3. What is the initial medical management for J’s symptoms related to PDA?

a). Oxygen therapy

b). Antibiotics for respiratory infections

c). Diuretics to manage heart failure

d). Propranolol to reduce heart rate

4. What complication is J at risk for if his PDA is not treated in a timely manner?

a). Pulmonary hypertension

b). Aortic stenosis

c). Myocardial infarction

d). Coarctation of the aorta

Reveal answers

Answers

  1. c) Patent Ductus Arteriosus (PDA)
  2. b) A continuous "machine-like" murmur below the left clavicle
  3. c) Diuretics to manage heart failure
  4. a) Pulmonary hypertension