Heart failure in infants and children — structured clinical encounter

Station brief (candidate)

You are the paediatric registrar in the emergency department. A six-week-old term infant presents with a three-week history of worsening tachypnoea, taking 40 minutes to finish 60 mL of feeds while sweating, and crossing two weight centiles downward. On examination there is a pansystolic murmur at the lower left sternal border, an apical mid-diastolic murmur, a hyperactive precordium, and hepatomegaly with the liver edge 3 cm below the costal margin. Oxygen saturations are 98 percent in air. The team asks you to establish the diagnosis and immediate management, then proceed to the echocardiogram, the closure plan, and the family counselling. You have 12 minutes with the team and 5 minutes for examiner discussion. ^[3]