Setting the first chart aside, Singh proceeded to review the next set of notes. The document showed that Pavit was eight days old, and the doctor had performed a physical examination focused on the baby's appearance, respiratory rate, and heart rate. A copy of the physical examination record is presented below. Chart 2. Physical examination Clinical data: 8-day old male neonate Complaints of: Increased precordial activity: Day 2 Breathlessness: Day 2 • Not accepting feeds: Day 2 History of: cyanosis/sweating over forehead / fever On examination: ⚫Heart rate (HR): 215 beats/minute (tachycardia) • Respiratory rate (RR): 72 breaths/minute (tachypnea) Questions 1. Why was the baby having increased precordial activity (visible pulsations on the anterior chest wall) and breathlessness? 2. How are these related to tachycardia and tachypnea documented? (Normal heart rate, 127-145 beats/min; normal respiratory rate is 40-44 breaths/min.) 3. What additional evidence shows a lack of tissue perfusion? 4. Would this be consistent with someone presenting with CHD?

Setting the first chart aside, Singh proceeded to review the next set of notes. The document showed that Pavit was eight days old, and the doctor had performed a physical examination focused on the baby's appearance, respiratory rate, and heart rate. A copy of the physical examination record is presented below. Chart 2. Physical examination Clinical data: 8-day old male neonate Complaints of: Increased precordial activity: Day 2 Breathlessness: Day 2 • Not accepting feeds: Day 2 History of: cyanosis/sweating over forehead / fever On examination: ⚫Heart rate (HR): 215 beats/minute (tachycardia) • Respiratory rate (RR): 72 breaths/minute (tachypnea) Questions 1. Why was the baby having increased precordial activity (visible pulsations on the anterior chest wall) and breathlessness? 2. How are these related to tachycardia and tachypnea documented? (Normal heart rate, 127-145 beats/min; normal respiratory rate is 40-44 breaths/min.) 3. What additional evidence shows a lack of tissue perfusion? 4. Would this be consistent with someone presenting with CHD?