Congenital Heart Disease — Acyanotic

A 6-year-old girl from rural Maharashtra is referred for evaluation of a systolic ejection murmur detected on routine school screening. She is asymptomatic, plays normally, and has no dyspnea or chest pain. Vital signs are normal. On auscultation, there is a grade 2/6 systolic ejection murmur at the left upper sternal border, with a normal S2. Chest X-ray is normal. What is the most appropriate next step in management?

A 2-year-old child with moderate mitral stenosis secondary to rheumatic heart disease presents with dyspnea on exertion and recurrent respiratory tract infections. Echocardiography confirms a mitral valve area of 1.2 cm². Medical management is initiated to reduce symptoms and prevent complications. Which drug is the preferred first-line agent for rate control and symptom relief in this patient?

A 3-month-old infant presents with failure to thrive, tachypnea, and hepatomegaly. Echocardiography confirms a large patent ductus arteriosus (PDA) with left-to-right shunt. Medical management is initiated. Which drug is the first-line pharmacological agent for closure of PDA in this neonate?

A 3-year-old boy from Delhi presents with recurrent respiratory tract infections and failure to thrive. His mother reports he tires easily during play and has a persistent cough. On examination, there is a continuous 'machinery' murmur best heard at the left infraclavicular region. Chest X-ray shows cardiomegaly with pulmonary congestion. Echocardiography confirms a left-to-right shunt with increased pulmonary blood flow. What is the most likely diagnosis?

In a patent ductus arteriosus, the characteristic continuous 'machinery' murmur is best heard at which anatomical location?