Cases in Electrocardiography
A 2-day-old infant was brought to the emergency department by her parents because she was not feeding well. She was born at 42 weeks gestation by a normal spontaneous vaginal delivery without complications. Immediately post-partum, the newborn had normal vital signs with no distress, and initially breast-fed well, voided, and stooled. Upon discharge home, however, the parents noted the infant had increasing difficulty feeding and episodes of “troubled breathing.”
On examination, the patient's weight was 3290 gm (45th percentile), head circumference 33.5 cm (10th percentile), and length 49.5 cm (25th percentile). Vital signs were pulse rate 135 beats/minute, blood pressure 83/49 mmHg. Head exam was notable for atypical facies with low-set, cupped ears, bifid uvula, and high-arched palate. Lungs were clear on auscultation. Cardiac examination was notable for a grade 3/6 systolic, low-pitched murmur. Abdomen examination was benign, extremities were well-perfused, and skin showed no evidence of cyanosis.
A 12-lead ECG (Fig. 1) was obtained. What is your diagnosis? See p. 10.