jean robert
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A 10 week-old apparently healthy infant is laid down for a nap. The mother sits in a rocking chair nearby reading. At one point,she hears the baby make a single small cry, but she keeps reading because the baby quiets quickly. Later, she gets up to check on the child, whom she finds dead. Careful autopsy would be most likely to reveal which of the following cardiac findings?
a) Endocarditis
b) Failure of development of the endocardial cushion
c) Large interventricular septal defect
d) Mitral valve stenosis
e) Right ventricular hypertrophy
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| Aashi
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SIDS------------------->E------------->RVH
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| sigh
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E.
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| Tiff
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E
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| new_n_lost
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Aashi wrote:
SIDS------------------->E------------->RVH
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| spinal shock
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why not A
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| new_n_lost
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spinal shock wrote:
why not A
Ok lets start this dicussion.
First tell us why do think its A and then we can discuss this question. Its an interesting topic.
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| spinal shock
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ok
the q didnot specify which type of endocarditis. it could be fungal leading to pulomery emboli. or due to CNS complications like meningitis, and the infection initially could be asymptomatic apart from mild fever for weeks (nelson 17th edition)
now why E?
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| new_n_lost
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spinal shock wrote:
ok
the q didnot specify which type of endocarditis. it could be fungal leading to pulomery emboli. or due to CNS complications like meningitis, and the infection initially could be asymptomatic apart from mild fever for weeks (nelson 17th edition)
now why E?
ok tell how did you assume its endocarditis. The question no where mentions Endocarditis other than in the choices.
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| spinal shock
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i just dont get it if rvh with vsd then it should be (blue babies). asymtomatic rvf leads to pumonary hypertention and eisimenger syndrome late in life.
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| spinal shock
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i thought mild fever which is initial symptom could be missed, so it was the only reasonable ans to me
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| spinal shock
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besides there is no rvf in the pathogenesis and risk factor of SIDS
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| Tiff
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I think the key to this question is to know that even though we don't really know the absolute true cause of SIDS, we do know it's something that causes respiratory failure. So a cardio-respiratory problem is likely. In this case RVH is the only one that would fit this picture.
Here's some supplemental reading that addresses this. Let me know if it's helpful.
"The cause or causes of SIDS are likely to be multifactorial. The triple risk model, proposed by Filiano and Kinney, suggests that SIDS represents an intersection of factors, including a vulnerable infant possessing intrinsic abnormalities in cardiorespiratory control, a critical period of development of homeostatic control mechanisms, and exogenous stressors." http://www.emedicine.com/ped/TOPIC2171.HTM
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| stochastic
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C
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| new_n_lost
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Spinal. Take it like this.
They asked what would you find at Autopsy. Right
So the child is/was apparently healthy no predisposing factors.
Then Asphyxia----> Pulmonary Congestion ----> Pulmonary Edema -----> RVH
or in simpler terms
Asphyxia ------> Alveolar hypoxia ---> pulmonary vasoconstriction ---> pulmonary vasoconstriction------> increased right ventricular afterload ---> heart failure with more tissue hypoxia
Edited by new_n_lost on 05/20/08 - 07:36 PM
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| hitesh
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If thats the mechanism, can RVH develop in such a short time? 
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| Tiff
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hitesh wrote:If thats the mechanism, can RVH develop in such a short time?
I think yes it could because the child would have a pre-existing weakness. As mentioned in the article I posted above, the infants can be vunerable to stressors because their defense mechanisms could either be structurally, functionally, or developmentally deficient. They are vulnerable because of abnormalities to their cardiorespiratory control.
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| jean robert
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Correct answer is E.(Right ventricular hypertrophy )
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| jean robert
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EXPLANATION
The baby is a victim of SIDS. The etiology remains unknown. Rare cases have been witnessed ,and some of the SIDS babies give a single small cry, as described in the question stem. Some of theses babies were premature at birth and some have upper respiratory infections in the preceding few days before death.
Findings at autopsy are subtle and may be absent.The cardiovascular system may show Right Ventricular hypertrophy, which is possibly secondary to smooth muscle hypertrophy in small pulmonary arteries, and possibly cardiac conduction system abnormalities.
Other features include Brainstem gliosis (suggesting Chronic hypoxia) , Extramedullary hematopoiesis and Retained periadrenal brown fat
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| new_n_lost
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hitesh wrote:If thats the mechanism, can RVH develop in such a short time?
It took time to understand that too. believe me.
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| spinal shock
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new _n_lost
thanks the mechanism is very clear i think you were right
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