Pediatric Heart Expert Forum
Low Cardiac Output?
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Low Cardiac Output?

Over the last couple weeks my 6 month old daughter is developing a really red face. It looks almost like a butterfly rash: her cheeks and nose get BRIGHT red, and sometimes the redness even extends up around her eyes and around her eyebrows, almost a blotchy red. At first our doctor thought it might be a rash, and gave us a hydrocortisone cream but it's not helping. Someone mentioned that low cardiac output can cause this. Could that be what's going on? She has a moderate, restrictive VSD and does have issues with right side failure, her liver often swells. She's on Lasix, Digoxin (only 0.5 ml once daily, weight is 5.7 kg), and Sprionolactone. Her respiratory rate is running high, but doesn't have any retractions. She's not eating as well, either, only about 20 oz per day, but she does have quite a bit of energy, she's very active, but she does nap 4-5 times per day and sleeps around 11 hours straight at night.
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Dear Mshanson,

The rash that you describe is concerning for a possible collagen-vascular disease or autoimmune-like rash, often described as a malar rash or, as you said, butterfly rash.  This rash can be seen in systemic lupus erythematosus and other similar diseases.  However, as I've discussed before, I cannot say whether this is involved with her findings, or not, without fully evaluating her.  I do not believe that low cardiac output causes a malar rash, nor do I have any demonstration that your daughter actually has low cardiac output in the face of a restrictive VSD.  There can be other right-sided obstructive problems that can cause liver swelling, including liver disease itself.  As previously mentioned, this picture of your daughter is definitely not right and needs further evaluation by a specialist.  It could be a double-chambered right ventricle, or there could be some other issues going on with her liver specifically.
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