In an infant with trisomy 21 and a large VSD, which tests would be appropriate to evaluate the potential for heart failure?

• A. Chest X-ray and electrocardiogram
• B. EEG and CT scan
• C. Abdominal ultrasound
• D. MRI of the heart

Answer: (A)

When evaluating potential heart failure in an infant with a large ventricular septal defect, the goal is to quickly assess heart size, pulmonary congestion, and the heart’s electrical status. A chest X-ray provides a clear picture of cardiomegaly and the lungs, showing how the heart is handling the increased blood flow and whether there are signs of pulmonary edema or vascular congestion that point toward heart failure. An electrocardiogram adds information about rhythm, heart rate, and electrical changes that reflect ventricular workload or hypertrophy; together, these tests give a practical, noninvasive sense of how hard the heart is working and whether heart failure is developing.

The other options don’t target these deficiencies as directly. EEG and CT scan focus on the brain, not the heart. Abdominal ultrasound assesses abdominal organs and structures rather than cardiac status. MRI of the heart is valuable for detailed anatomy and function but is more time-consuming, often requires sedation, and isn’t the first-line screen for assessing potential heart failure in an infant with a large VSD.