Tetralogy of Fallot - Revision history

Rossdonaldson1: /* Background */

2024-11-06T17:35:17Z

Background

← Older revision		Revision as of 17:35, 6 November 2024
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	==Background==		==Background==
			[[File:Heart tetralogy fallot.png\|thumb\|Heart with tetralogy of fallot A: Pulmonary stenosis; B: Overriding aorta; C: Ventricular septal defect (VSD); D: Right ventricular hypertrophy]]
	*Most common cyanotic CHD manifesting in post-infancy period		*Most common cyanotic CHD manifesting in post-infancy period
	*Acute episodes of hypoxia and cyanosis caused by right-to-left shunting across the [[VSD]] ('Tet Spells')		*Acute episodes of hypoxia and cyanosis caused by right-to-left shunting across the [[VSD]] ('Tet Spells')

Rossdonaldson1: /* Clinical Features */

2024-04-10T16:19:23Z

Clinical Features

← Older revision		Revision as of 16:19, 10 April 2024
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	==Clinical Features==		==Clinical Features==
			[[File:CongenitalHeartCase-133.jpg\|thumb\|Digital clubbing with cyanotic nail beds in an otherwise healthy-appearing, asymptomatic young adult with Tetralogy of Fallot.]]
	*Systolic ejection [[murmur]] along the left sternal border<ref name="horeczko">Horeczko T, Inaba AS: Cardiac Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 171: p 2139-2169.</ref>		*Systolic ejection [[murmur]] along the left sternal border<ref name="horeczko">Horeczko T, Inaba AS: Cardiac Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 171: p 2139-2169.</ref>
	*Cyanosis worse during feeding and crying<ref name="horeczko"></ref>		*Cyanosis worse during feeding and crying<ref name="horeczko"></ref>

Rossdonaldson1: /* Differential Diagnosis */

2022-05-14T12:29:45Z

Differential Diagnosis

← Older revision		Revision as of 12:29, 14 May 2022
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	==Differential Diagnosis==		==Differential Diagnosis==
			{{DDX syncope peds}}
	{{Congenital heart disease DDX}}		{{Congenital heart disease DDX}}

Rossdonaldson1: Rossdonaldson1 moved page Tetralogy of fallot to Tetralogy of Fallot over redirect

2021-10-23T12:16:45Z

Rossdonaldson1 moved page Tetralogy of fallot to Tetralogy of Fallot over redirect

← Older revision	Revision as of 12:16, 23 October 2021
(No difference)

Cdichang: /* Tetralogy */

2020-05-16T09:19:52Z

Tetralogy

← Older revision		Revision as of 09:19, 16 May 2020
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	*During the spell there is hypercarbia and hypoxemia (which further increases pulmonary vascular resistance). The process compounds itself creating worsening right-to-left shunting, hyperpnea, right outflow tract obstruction and increased systemic venous return		*During the spell there is hypercarbia and hypoxemia (which further increases pulmonary vascular resistance). The process compounds itself creating worsening right-to-left shunting, hyperpnea, right outflow tract obstruction and increased systemic venous return
	===Tetralogy===		===Tetralogy===
	#[[VSD]]		*[[VSD]]
	#RV outflow obstruction (pulmonic stenosis)		*RV outflow obstruction (pulmonic stenosis)
	#Overriding aorta		*Overriding aorta
	#RV hypertrophy		*RV hypertrophy

	==Clinical Features==		==Clinical Features==

Cdichang: /* Analgesia */

2020-05-16T09:19:25Z

Analgesia

← Older revision		Revision as of 09:19, 16 May 2020
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	===[[Analgesia]]===		===[[Analgesia]]===
	#[[Morphine]] 0.1-0.2mg/kg IV or IM		*[[Morphine]] 0.1-0.2mg/kg IV or IM
	#*Goal is to ideally avoid IV placement if possible		**Goal is to ideally avoid IV placement if possible
	#*Decreases ventilatory drive, thus decreasing systemic venous return		**Decreases ventilatory drive, thus decreasing systemic venous return
	#*Caveat is decrease in vascular resistance		**Caveat is decrease in vascular resistance
	#[[Intranasal Sedation#Intranasal Medications\|Intranasal Fentanyl]] 1.5-2 mcg/kg range <ref>Tsze DS, Vitberg YM, Berezow3 J, Starc TJ, Dayan PS. Treatment of tetralogy of Fallot hypoxic spell with in- tranasal fentanyl. Pediatrics. 2014 Jul;134(1):e266-9.</ref>		*[[Intranasal Sedation#Intranasal Medications\|Intranasal Fentanyl]] 1.5-2 mcg/kg range <ref>Tsze DS, Vitberg YM, Berezow3 J, Starc TJ, Dayan PS. Treatment of tetralogy of Fallot hypoxic spell with in- tranasal fentanyl. Pediatrics. 2014 Jul;134(1):e266-9.</ref>
	#*Only one case report but IN administration may avoid the pain from a needle stick		**Only one case report but IN administration may avoid the pain from a needle stick

	===[[Ketamine]]===		===[[Ketamine]]===

Cdichang: /* Background */

2020-05-16T09:17:59Z

Background

← Older revision		Revision as of 09:17, 16 May 2020
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	#Decreased systemic vascular resistance leading to right-to-left shunting		#Decreased systemic vascular resistance leading to right-to-left shunting

	*During the spell there is hypercarbia and hypoxemia (which further increases pulmonary vascular resistance). The process compounds itself creating worsening right-to-left shunting, hyperpnea, right outflow tract obstruction and increased systemic venous return.		*During the spell there is hypercarbia and hypoxemia (which further increases pulmonary vascular resistance). The process compounds itself creating worsening right-to-left shunting, hyperpnea, right outflow tract obstruction and increased systemic venous return
	===Tetralogy===		===Tetralogy===
	#[[VSD]]		#[[VSD]]

ClaireLewis: /* Evaluation */

2019-09-26T17:06:08Z

Evaluation

← Older revision		Revision as of 17:06, 26 September 2019
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	==Evaluation==		==Evaluation==
	[[File:HeartTOP.jpg\|thumb\|CXR of child with tetralogy of Fallot]]		[[File:HeartTOP.jpg\|thumb\|CXR of child with tetralogy of Fallot]]
	*~~Echo~~: Gold standard		*[[Echocardiography]]: Gold standard
	*[[CXR]]: shows the classic “boot-shaped” heart		*[[CXR]]: shows the classic “boot-shaped” heart
	**Decreased pulmonary vascularity (due to pulmonic stenosis)		**Decreased pulmonary vascularity (due to pulmonic stenosis)

ClaireLewis at 04:09, 24 September 2019

2019-09-24T04:09:26Z

← Older revision		Revision as of 04:09, 24 September 2019
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	*Cyanosis worse during feeding and crying<ref name="horeczko"></ref>		*Cyanosis worse during feeding and crying<ref name="horeczko"></ref>
	*May squat to relieve symptoms: increases afterload and decreases shunt<ref name="horeczko"></ref>		*May squat to relieve symptoms: increases afterload and decreases shunt<ref name="horeczko"></ref>
	*Acute [[respiratory]] ~~distress~~ (Tet Spells) due to increased right outflow tract obstruction<ref name="horeczko"></ref>		*Acute [[Shortness of breath (peds)\|respiratory distress]] (Tet Spells) due to increased right outflow tract obstruction<ref name="horeczko"></ref>
	*Chronic [[hypoxemia]] causes a compensatory polycythemia and clubbing of the fingers and toes		*Chronic [[hypoxemia]] causes a compensatory polycythemia and clubbing of the fingers and toes

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	*Consider [[IO line]] as resuscitation tool		*Consider [[IO line]] as resuscitation tool

	===Analgesia===		===[[Analgesia]]===
	#[[Morphine]] 0.1-0.2mg/kg IV or IM		#[[Morphine]] 0.1-0.2mg/kg IV or IM
	#*Goal is to ideally avoid IV placement if possible		#*Goal is to ideally avoid IV placement if possible
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	===[[Beta blockers]]===		===[[Beta blockers]]===
	*Should be administered in ~~consulation~~ with cardiology and pediatric surgery		*Should be administered in consultation with cardiology and pediatric surgery
	*Relax spasm causing RV outflow obstruction		*Relax spasm causing RV outflow obstruction
	*Slows HR, decrease right to left shunting		*Slows HR, decrease right to left shunting

ClaireLewis at 00:42, 2 September 2019

2019-09-02T00:42:02Z

← Older revision		Revision as of 00:42, 2 September 2019
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	==Clinical Features==		==Clinical Features==
	*Systolic ejection murmur along the left sternal border<ref name="horeczko">Horeczko T, Inaba AS: Cardiac Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 171: p 2139-2169.</ref>		*Systolic ejection [[murmur]] along the left sternal border<ref name="horeczko">Horeczko T, Inaba AS: Cardiac Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 171: p 2139-2169.</ref>
	*Cyanosis worse during feeding and crying<ref name="horeczko"></ref>		*Cyanosis worse during feeding and crying<ref name="horeczko"></ref>
	*May squat to relieve symptoms: increases afterload and decreases shunt<ref name="horeczko"></ref>		*May squat to relieve symptoms: increases afterload and decreases shunt<ref name="horeczko"></ref>
	*Acute respiratory distress (Tet Spells) due to increased right outflow tract obstruction<ref name="horeczko"></ref>		*Acute [[respiratory]] distress (Tet Spells) due to increased right outflow tract obstruction<ref name="horeczko"></ref>
	*Chronic hypoxemia causes a compensatory polycythemia and clubbing of the fingers and toes		*Chronic [[hypoxemia]] causes a compensatory polycythemia and clubbing of the fingers and toes

	==Differential Diagnosis==		==Differential Diagnosis==
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	#*Decreases ventilatory drive, thus decreasing systemic venous return		#*Decreases ventilatory drive, thus decreasing systemic venous return
	#*Caveat is decrease in vascular resistance		#*Caveat is decrease in vascular resistance
	#[[Intranasal Sedation#Intranasal Medications\|Intranasal Fentanyl]] 1.5-2 mcg/kg range <ref>Tsze DS, Vitberg YM, Berezow3 J, Starc TJ, Dayan PS. Treatment of ~~tetrology~~ of Fallot hypoxic spell with in- tranasal fentanyl. Pediatrics. 2014 Jul;134(1):e266-9.</ref>		#[[Intranasal Sedation#Intranasal Medications\|Intranasal Fentanyl]] 1.5-2 mcg/kg range <ref>Tsze DS, Vitberg YM, Berezow3 J, Starc TJ, Dayan PS. Treatment of tetralogy of Fallot hypoxic spell with in- tranasal fentanyl. Pediatrics. 2014 Jul;134(1):e266-9.</ref>
	#*Only one case report but IN administration may avoid the pain from a needle stick		#*Only one case report but IN administration may avoid the pain from a needle stick