Difference between revisions of "Tetralogy of fallot"

(restructured, reference)
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== Background ==
 
== Background ==
*Most common cyanotic CHD manifesting in postinfancy period
+
*Most common cyanotic CHD manifesting in post-infancy period
 
*Tetralogy:
 
*Tetralogy:
 
**VSD
 
**VSD
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**Overriding aorta
 
**Overriding aorta
 
**RV hypertrophy
 
**RV hypertrophy
== Diagnosis ==
+
 
*Cyanosis
+
==Clinical Presentation==
*Systolic thrill/ejection murmur, loud S2
+
*Systolic ejection murmur along the left sternal border<ref>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>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>
 +
*May squat to relieve symptoms: increases afterload and decreases shunt<ref>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>
 +
*Acute respiratory distress (Tet Spells) due to increased right outflow tract obstruction<ref>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>
 +
 
 
== Work-Up ==
 
== Work-Up ==
 +
*Echo
 +
*CXR: shows the classic “boot-shaped” heart
  
 
== DDx ==
 
== DDx ==
 +
*[[Congenital heart disease]]
  
 
== Treatment ==
 
== Treatment ==
 
+
*Definitive Treatment: Surgery
 +
*Acute Presentation:
 +
#Valsalva
 
#Place in knee-chest position
 
#Place in knee-chest position
 
##Increases SVR > more blood into pulm ciruclation
 
##Increases SVR > more blood into pulm ciruclation
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##Improves RV filling
 
##Improves RV filling
 
#Beta blockers IV
 
#Beta blockers IV
##Relaxtion of RVOT
+
##Relaxation of RVOT
 
#Phenylephrine
 
#Phenylephrine
 
##Similar to knee-chest position
 
##Similar to knee-chest position
 
== Disposition ==
 
  
 
== See Also ==
 
== See Also ==
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== Source ==
 
== Source ==
 +
*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.
 +
*UpToDate
  
UpToDate
+
[[Category:Cards]]
 
+
[[Category:Peds]]
<br/>[[Category:Cards]] <br/> <br/>
 

Revision as of 02:28, 13 January 2015

Background

  • Most common cyanotic CHD manifesting in post-infancy period
  • Tetralogy:
    • VSD
    • RV outflow obstruction (pulmonic stenosis)
    • Overriding aorta
    • RV hypertrophy

Clinical Presentation

  • Systolic ejection murmur along the left sternal border[1]
  • Cyanosis worse during feeding and crying[2]
  • May squat to relieve symptoms: increases afterload and decreases shunt[3]
  • Acute respiratory distress (Tet Spells) due to increased right outflow tract obstruction[4]

Work-Up

  • Echo
  • CXR: shows the classic “boot-shaped” heart

DDx

Treatment

  • Definitive Treatment: Surgery
  • Acute Presentation:
  1. Valsalva
  2. Place in knee-chest position
    1. Increases SVR > more blood into pulm ciruclation
  3. Morphine 0.1-0.2Mg/kg IV or IM
    1. Mechanism of action unclear
  4. Fluids IV
    1. Improves RV filling
  5. Beta blockers IV
    1. Relaxation of RVOT
  6. Phenylephrine
    1. Similar to knee-chest position

See Also

Congenital Heart Disease

Source

  • 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.
  • UpToDate
  • 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.
  • 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.
  • 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.
  • 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.