Congenital Heart Defects – Case Study #1
You are working in the hospital when Samantha, a 2-day old infant is diagnosed with a continuous, systolic,
grade 3 heart murmur in the pulmonic area of the chest. This is the parent’s first child and they are
extremely worried about their 6-week premature newborn. Samantha has full, bounding pulses and weighed
5 lb. 6 oz. at birth, but has lost 3 ounces in the last 2 days. The day after Samantha was born, the parents
were told about her heart murmur and that an EKG, echocardiogram and chest X-ray are needed to
determine the cause. The tests show that she has a patent ductus arteriosus (PDA). The physician has
prescribed three doses of a medication to aid in the closure of the duct. You explain that her vital signs and
urine output will need to be monitored closely for decreases while she is on the medicine.
Several days later the heart murmur is still heard; the medicine did not work. The parents want to avoid
surgery if possible and the doctor explains if the ductus closes by the time she is 9 to 12 months old, and she
is without symptoms, surgery could be avoided. If the PDA is not corrected, her lifespan will be shortened.
She is discharged from the hospital thriving and breastfeeding well, and the doctor advises about watching
for poor weight gain, swelling, intercostal retractions, and breathing more than 60 times per minute. A
follow-up appointment is made for one week later.
1 How would you explain PDA to the parents?
2 What was the most likely cause of Samantha’s weight loss? Is it the PD! that caused the weight loss?
3 What is the physiologic reason that Samantha’s life would be shortened if she does not get surgical
correction of her PDA?
4 How would you describe congestive heart failure?
5 The type of defect that Samantha is experiencing is a defect that ____________ pulmonary blood
flow.
6 Does a child with a PDA experience cyanosis?
7 The name of the IV medication that is used to help the closure of the patent ductus arteriosus within
7 days of the infant’s birth is _________________________________
8 After transition from fetal circulation to pulmonary circulation (postnatal) occurs, blood flows from
the _____ ______ through the PDA to the___________________________
9. What is the physiologic result of increased blood volume in the heart overloading the pulmonary system?