Anomalous left coronary artery masquerading as infantile bronchiolitis
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W H Franklin1, A M Dietrich, R W Hickey
1Department of Pediatrics, Ohio State University, Columbus.
Insights
Infants under six months with anomalous left coronary artery may present with wheezing. Chest X-rays are crucial before administering beta-agonist agents to prevent adverse events like cardiopulmonary collapse.
Area of Science:
- Pediatric Cardiology
- Neonatal Medicine
- Diagnostic Imaging
Background:
- Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect.
- Infants with ALCAPA can present with non-specific symptoms, including respiratory distress mimicking wheezing.
- Beta-agonist agents are commonly used for wheezing but may pose risks in undiagnosed cardiac conditions.
Observation:
- Four infants under six months with ALCAPA presented with wheezing.
- All infants had cardiomegaly on chest radiographs.
- Two infants received beta-agonist agents; one experienced cardiopulmonary collapse after administration.
Findings:
- Wheezing in young infants can be a symptom of ALCAPA.
- Beta-agonist agents may precipitate adverse cardiovascular events in infants with ALCAPA.
- Chest radiography is a valuable tool for identifying cardiomegaly in infants with respiratory symptoms.
Implications:
- Physicians should consider ALCAPA in infants presenting with unexplained wheezing and cardiomegaly.
- A low threshold for obtaining chest radiographs before administering beta-agonists to infants with first-time wheezing is recommended.
- Early diagnosis of ALCAPA is critical for timely surgical intervention and improved outcomes.
Abstract:
Four infants less than six months of age with anomalous left coronary artery from the pulmonary artery who present with symptoms of wheezing are described. All had cardiomegaly on chest radiographs and because of wheezing received beta-agonist agents (albuterol alone or with epinephrine). One developed cardiopulmonary collapse secondary to supraventricular tachycardia after administration of these agents. The literature is reviewed for utility of chest radiographs in infants presenting with wheezing and for the efficacy of beta-adrenergic agents in infants less than six months of age. The authors suggest that physicians have a low threshold for obtaining a chest radiograph prior to treating a first-time wheezing infant less than six months of age with a beta-agonist agent.