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A 10-week-old apparently healthy infant is laid down for a nap. The mother sits in a rocking chair nearby reading. At one point, she hears the baby make a single small cry, but she keeps reading because the baby quiets quickly. Later, she gets up to check on the child, whom she finds dead.Careful autopsy would be most likely to reveal which of the following cardiac findings?
Options:
A. Endocarditis
B. Failure of development of the endocardial cushion
C. Large interventricular septal defect
D. Mitral valve stenosis
E. Right ventricular hypertrophy
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d? mitral valve prolapse?
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The correct answer is E. The baby is probably a victim of sudden infant death syndrome (SIDS). The etiology remains unknown. Rare cases have been witnessed, and some of the SIDS babies give a single small cry, as described in the question stem. Some of these babies were premature at birth and some have upper respiratory infections in the preceding few days before death. Findings at autopsy are subtle and may be absent. The cardiovascular system may show right ventricular hypertrophy, which is possibly secondary to smooth muscle hypertrophy in small
pulmonary arteries, and possibly cardiac conduction system abnormalities. Other features include brainstem gliosis (suggesting chronic hypoxia), extramedullary hematopoiesis, and retained
periadrenal brown fat.
A baby with endocarditis (choice A) would be very obviously ill.
A serious congenital heart defect, such as failure of development of the endocardial cushion (choice B), large interventricular septal defect (choice C), or a mitral value stenosis (choice D) would have been picked up in the comprehensive physical examination at the child's birth.
