Which sign may indicate congestive heart failure in an infant with a large ventricular septal defect?

Which sign may indicate congestive heart failure in an infant with a large ventricular septal defect?

• A. Hypertension
• B. Bradycardia
• C. Lethargy
• D. Tachycardia and tachypnea

Answer: (D)

In a large ventricular septal defect, a big left-to-right shunt increases pulmonary blood flow, overloading the left ventricle and causing pulmonary congestion. The body compensates by increasing both the heart rate and the respiratory rate to maintain oxygen delivery, so tachycardia and tachypnea are classic early signs of congestive heart failure in these infants. Hypertension isn’t typical of pediatric CHF, bradycardia would suggest poor perfusion, and lethargy is nonspecific. The combination of a fast heart rate with rapid breathing specifically points to the heart and lungs working harder due to volume overload from the defect.

In a large ventricular septal defect, a big left-to-right shunt increases pulmonary blood flow, overloading the left ventricle and causing pulmonary congestion. The body compensates by increasing both the heart rate and the respiratory rate to maintain oxygen delivery, so tachycardia and tachypnea are classic early signs of congestive heart failure in these infants. Hypertension isn’t typical of pediatric CHF, bradycardia would suggest poor perfusion, and lethargy is nonspecific. The combination of a fast heart rate with rapid breathing specifically points to the heart and lungs working harder due to volume overload from the defect.