A child, age 4, is admitted with a tentative diagnosis of congenital heart disease.
When assessment reveals a bounding radial pulse coupled with a weak femoral pulse, nurse Ellen suspects that the child has:
- a. patent ductus arteriosus.
- b. coarctation of the aorta.
- c. a ventricular septal defect.
- d. truncus arteriosus.
Answer B.
Coarctation of the aorta causes signs of peripheral hypoperfusion, such as a weak femoral pulse and a bounding radial pulse. These signs are rare in patent ductus arteriosus, ventricular septal defect (VSD), and truncus arteriosus.Based on the presented information, the most likely diagnosis for the child with a bounding radial pulse and weak femoral pulse is: b. coarctation of the aorta (CoA)
Here's why:
- Patent ductus arteriosus (PDA):
This congenital heart defect involves a persistent opening between the aorta and pulmonary artery. While it can cause bounding pulses, it typically wouldn't lead to a significant difference in strength between the radial and femoral pulses.
- Ventricular septal defect (VSD):
This defect involves a hole in the wall between the heart's ventricles. While VSDs can cause various symptoms, a significant difference in pulse strength between the upper and lower extremities is not a typical presentation.
- Truncus arteriosus:
This rare defect involves a single large artery arising from the heart instead of the separate aorta and pulmonary artery. While it can cause various symptoms, the specific pulse findings described are more consistent with coarctation of the aorta.
Coarctation of the aorta (CoA):
is a congenital malformation where the aorta is narrowed in a specific location, typically just beyond the left subclavian artery. This narrowing restricts blood flow to the lower body, leading to:
- Bounding radial pulses:
Due to the increased pressure in the upper body arteries caused by the narrowing.
- Weak femoral pulses:
Due to the decreased blood flow reaching the lower body.
Therefore, considering the child's symptoms and the typical presentation of CoA, nurse Ellen's suspicion of this diagnosis is most likely accurate.
It's important to remember that this is only a preliminary assessment based on limited information. A thorough medical evaluation and additional tests are crucial for confirming the diagnosis and determining the best course of treatment.
