Difference between revisions of "Tetralogy of fallot"

(DDx)
(Treatment)
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#Phenylephrine
 
#Phenylephrine
 
##Similar to knee-chest position
 
##Similar to knee-chest position
 +
#Prostaglandin E1 0.1 mg/kg bolus followed by infusion 0.05 to 0.1 mg/kg/min
 +
## Maintains the ductus
 +
## Side Effects:  Hypotension, Bradycardia, Seizures and Apnea
  
 
== See Also ==
 
== See Also ==

Revision as of 20:50, 21 February 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

Differential Diagnosis

Congenital Heart Disease Types

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
  7. Prostaglandin E1 0.1 mg/kg bolus followed by infusion 0.05 to 0.1 mg/kg/min
    1. Maintains the ductus
    2. Side Effects: Hypotension, Bradycardia, Seizures and Apnea

See Also

Source

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. Knipe K et al. Cyanotic congenital heart diseases. Radiopaedia. http://radiopaedia.org/articles/cyanotic-congenital-heart-disease