Tetralogy of fallot

Revision as of 06:58, 13 January 2015 by Rossdonaldson1 (talk | contribs) (Rossdonaldson1 moved page Tetralogy of Fallot to Tetralogy of fallot)

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.