Diferencia entre revisiones de «Tetralogy of Fallot»

Sin resumen de edición
(restructured, reference)
Línea 1: Línea 1:
== Background ==
== Background ==
*Most common cyanotic CHD manifesting in postinfancy period
*Most common cyanotic CHD manifesting in post-infancy period
*Tetralogy:
*Tetralogy:
**VSD
**VSD
Línea 6: Línea 6:
**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
Línea 22: Línea 31:
##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 ==
Línea 32: Línea 39:


== 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/>

Revisión del 02:28 13 ene 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
  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.
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