Difficult time in catching her breath and tires quickly

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D. D. is a 2-year-old girl brought into the pediatrician by her father. She has always had a difficult time in catching her breath and tires quickly. She is small for her developmental age and appears cyanotic. She tries to giggle in her daddy's lap, but a coughing fit brings her to tears. Her family has been moving constantly for two years, due her father working as a part-time school teacher. This has prevented her from seeing a regular pediatrician, but her father finally got a full-time job that allowed him to bring her in under insurance. Her mother died at childbirth. Her family history is otherwise unremarkable. She presents with cyanosis, dilated pupils, and reduced muscle tone. Auscultation is negative for the lungs, but detects a faint murmur that doesn't correlate with either of the valve closings.

Reference no: EM133455588

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