My heart hurts for you

I got this baby as a patient that was 2 weeks old and had a chief complaint of wheezing and difficulty breathing. Chest Xray in the ER showed signs of bronchiolitis possibly related to RSV. The baby was admitted and we began to treat the infant and give oxygen. We were able to get the symptoms under control and within 2 days we had the baby breathing well and almost all symptoms were gone.

On the morning of the 3rd day I examined the baby and I was hoping to discharge the baby that day. As I was listening to the lungs I heard some irregularities with the heart. I made sure to listen and re-listen to verify that I was actually hearing a murmur. I was pretty certain that I was hearing a murmur that is heard with patent foramen ovale (PFO) which is a hole between the right atrium and left atrium. It usually closes when the baby is born and is considered an abnormality if it does not close. It can be benign depending on the size of it and will sometimes close with medication or after 4-6 months.

I called in my senior resident to listen and he verified that there was a murmur and told me good job for picking up on it. We presented the case to the attending physician at morning rounds and he listened and agreed with our assessment. So we ordered a EKG and echocardiogram. That afternoon we did an echocardiogram and were surprised at the pathology we found. There was a significant hole between the left and right atrium and a hole between the aorta and pulmonary artery and  there was significant right sided hypertrophy. The baby has some serious problems with her heart. I had to explain to the parents what the issues were and also explain that until we did further tests we were not certain what was wrong.

The parents were devastated that there was anything wrong. This is their first baby. We had to keep the baby in the hospital and ordered a multitude of tests to try and figure out what is wrong with the baby. Often these kinds of heart issues are part of an entire syndrome and can be fairly serious if not fatal. Currently we are waiting to do more tests and trying to solve this riddle. In the meantime the parents wait anxiously without any idea of how it will all turn out.