Case Scenario: A 4-year-old girl named Amy is below the 5th percentile for height and weight for age and becomes easily fatigued. On physical examination, she appears cyanotic. Her temperature is normal, pulse 82 bpm, respirations 16/min and BP is 105/65 mmHg. ABG reveals decreased oxygen saturation. Her physician refers her to a pediatric cardiologist for evaluation. 7A. What are the genetic and environmental factors that are associated with the development of congenital heart defects?