Congenital Heart Disease

In an infant who is tachypneic and cyanotic, it may be difficult clinically to distinguish between cardiac and pulmonary disease. The physical examination is important, but an infant can have a congenital heart lesion and not have an audible murmur. The oxygen challenge test (OCT) can help to distinguish between pulmonary and cardiac causes. The OCT helps determine whether a significant cardiac anomaly is causing a right-to-left shunt, or whether oxygenated blood is mixing with unoxygenated blood. Arterial blood gases (ABGs) are tested while the infant is breathing room air and after the infant has been breathing 100% oxygen for at least 15 minutes. On 100% oxygen, the Po2 should increase to greater than 150 mm Hg in the infant without cardiac disease (Sasid-haran, 2004). If congenital heart disease is strongly suspected, the infant should be readily transferred to a facility with pedi-atric echocardiography and neonatal intensive care facilities.

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