Rosh Pediatrics Practice Exam

Which condition in a 6-month-old with a fixed and split second heart sound is explained by abnormal blood flow postnatally?

1. Flow of deoxygenated blood from the right atrium to the left atrium

2. Flow of oxygenated blood from the aorta to the pulmonary arteries

3. Flow of oxygenated blood from the left atrium to the right atrium

4. Flow of oxygenated blood from the left ventricle to the right ventricle

The correct answer is: Flow of oxygenated blood from the left atrium to the right atrium

A fixed and split second heart sound in an infant suggests the presence of certain congenital heart defects that lead to abnormal blood flow after birth. In typical development, the heart structure is meant to separate oxygenated and deoxygenated blood. However, in specific conditions such as an atrial septal defect (ASD), there is an abnormal flow of oxygenated blood. In the case of a 6-month-old, the correct answer involves the flow of oxygenated blood from the left atrium to the right atrium. This situation occurs in an ASD where there is a defect in the septum that separates the two atria, allowing for blood that should be circulating in a closed loop (from the left atrium to the left ventricle and then to the aorta) to instead flow back into the right atrium. This mixing of oxygenated blood can lead to increased blood flow to the lungs and various symptoms associated with left-to-right shunting. Understanding this flow is critical because it can contribute to heart failure or pulmonary issues over time due to the increased workload on the right side of the heart. Recognizing the characteristic heart sounds and their implications helps in diagnosing and managing congenital heart diseases effectively in pediatric practice.