Question 1427
{"accessible":false,"alternatives":[{"id":7111,"text":"Amitriptyline"},{"id":7112,"text":"Carbamazepine"},{"id":7113,"text":"Lithium"},{"id":7114,"text":"Phenytoin"},{"id":7115,"text":"Sodium valproate"}],"archived":false,"correctAlternativeId":7113,"explanation":"\u003cp\u003eEbstein\u0026nbsp;anomaly is a congenital heart disease, characterized by apical displacement of the tricuspid valve. This results in an enlarged right atrium, with atrialization of the ventricle above the valve, a small right ventricle and, in many cases, tricuspid regurgitation.\u003c/p\u003e\u003cp\u003eThe imaging findings (and symptoms) depend on how far the tricuspid valve is displaced towards the apex. There is often cardiomegaly (specifically right sided cardiomegaly), with the heart classically being described as 'box shaped' on chest radiographs.\u003c/p\u003e\u003cp\u003eIn some cases, presentation may be antenatal, in other cases presentation will be at birth. Patients may present with:\u003c/p\u003e\u003cul\u003e\n\u003cli\u003eheart failure\u003c/li\u003e\n\u003cli\u003etachyarrhythmias (both antenatally and postnatally)\u003c/li\u003e\n\u003cli\u003ehydrops fetalis can occur if presents antenatally\u003c/li\u003e\n\u003cli\u003ecyanosis (patients often have other congenital abnormalities, particularly septal defects and right-to-left shunting can occur)\u003c/li\u003e\n\u003cli\u003esudden cardiac death (generally secondary to arrhythmia)\u003c/li\u003e\n\u003c/ul\u003e\u003cp\u003eEbstein anomaly is classically said to be associated with maternal lithium exposure, however some recent studies have questioned this association. Current evidence is unclear, but lithium is still mentioned in many guidelines. There is no documented association of the other listed medications with Ebstein anomaly so lithium is the most appropriate answer.\u003c/p\u003e","id":1427,"imageUrl":null,"imageAttribution":null,"imageAttributionCaseInfo":null,"firstQuestionPath":"/questions/1427","nextQuestionPath":null,"relatedArticles":[{"id":7365,"title":"Ebstein anomaly","link":"/articles/ebstein-anomaly?lang=us"},{"id":9393,"title":"Hydrops fetalis","link":"/articles/hydrops-fetalis?lang=us"},{"id":24229,"title":"Tricuspid valve regurgitation","link":"/articles/tricuspid-valve-regurgitation-1?lang=us"}],"alsoUsedIn":[],"stem":"\u003cp\u003eA neonate with heart failure and intermittent tachyarrythmia\u0026nbsp;is\u0026nbsp;found to have severe right-sided cardiomegaly on chest X-ray carried out on day one of life. Echocardiography (and later cross-sectional imaging) demonstrates a tricuspid valve that is close to the apex of the heart, with a small right ventricle and a markedly enlarged right atrium.\u003c/p\u003e\u003cp\u003eWhich one of the below medications \u003cstrong\u003emay \u003c/strong\u003ebe associated with development of this condition?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/1427"}],"attemptsPercentages":[{"alternativeId":"7113","percentage":71},{"alternativeId":"7114","percentage":14},{"alternativeId":"7115","percentage":7},{"alternativeId":"7112","percentage":4},{"alternativeId":"7111","percentage":3}],"promptToLogin":false,"questionManager":false,"articleId":"box-shaped-heart"}