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Tetralogy of Fallot

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Paediatrics (Cardio) Mind Map on Tetralogy of Fallot, created by v.djabatey on 28/01/2014.
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Mind Map by v.djabatey, updated more than 1 year ago
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Created by v.djabatey almost 11 years ago
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Resource summary

Tetralogy of Fallot
  1. the commonest cause of cyanotic congenital heart disease
    1. clinical features
      1. 4 cardinal anatomical features
        1. large VSD
          1. overriding of aorta wrt ventricular septum
            1. subpulmonary stenosis
              1. causing right ventricular outflow obstruction
              2. right ventricular hypertrophy
              3. Sx
                1. classical description
                  1. severe cyanosis
                    1. hypercyanotic spells
                      1. rapid increase in cyanosis
                        1. assoc w/ irritability or inconsolable crying
                          1. due to severe hypoxia
                          2. assoc w/ breathlessness and pallor
                            1. due to acidosis
                          3. short murmur during spell
                            1. complications
                              1. myocardial infarction
                                1. cerebrovascular accidents
                                  1. death
                                2. squatting on exercise
                                  1. develops in late infancy
                                    1. rare in developed countires
                                  2. signs
                                    1. in older children
                                      1. clubbing: fingers & toes
                                      2. loud harsh ejection systolic murmur
                                        1. at left sternal edge
                                          1. from day 1 of life
                                          2. murmur will shorten & cyanosis will increase
                                            1. with increasing right ventricular outflow tract obstruction
                                              1. mostly muscular and below pulmonary valve
                                      3. diagnosed
                                        1. antenatally
                                          1. detection of murmur in 1st 2 months of life
                                            1. cyanosis at this stage may not be obvious
                                          2. Ix
                                            1. CXR
                                              1. relatively small heart
                                                1. uptilted apex (boot shaped)
                                                  1. due to right ventricular hypertrophy
                                                  2. right sided aortic arch
                                                    1. pulmonary artery bay
                                                      1. classic feature
                                                        1. concavity on left heart border
                                                          1. where convex-shaped main pul a & right ventricular outflow tract would normally be profiled
                                                        2. decreased pulmonary vascular markings
                                                          1. due to reduced pulmonary blood flow
                                                        3. ECG
                                                          1. normal at birth
                                                            1. right ventricular hypertrophy when older
                                                              1. upright T wave in V1, no S wave (pure R wave)
                                                            2. Echo
                                                              1. cardinal features shown
                                                                1. but cardiac catherisation needed to show anatomy of coronary aa
                                                            3. Mx
                                                              1. initially medical
                                                                1. then surgery @ 6 months old
                                                                  1. close VSD
                                                                    1. relieve right ventricular outflow obstruction
                                                                      1. sometimes w/ artificial patch going across pulmonary valve
                                                                  2. neonates who are very cyanosed
                                                                    1. need shunt to increase pulmonary blood flow
                                                                      1. surgically done
                                                                        1. modified Blalock-Taussig shunt
                                                                          1. surgical placement of artificial tube btw subclavian a and pulmonary a
                                                                          2. balloon dilatation of right ventricular outflow tract
                                                                      2. hypercyanotic spells
                                                                        1. usually self-limitig
                                                                          1. followed by period of sleep
                                                                            1. if prolonged (>15 mins) require prompt Rx
                                                                              1. sedation & pain relief
                                                                                1. morphine
                                                                                2. iv propanolol or an alpha adrenoceptor agonist
                                                                                  1. works as peripheral vasoconstrictor
                                                                                    1. relieves subpulmonary muscular obstruction that causes reduced pulmonary blood flow
                                                                                    2. iv volume adminstration
                                                                                      1. bicarbonate
                                                                                        1. correct acidosis
                                                                                        2. muscle paralysis and ventilation
                                                                                          1. to reduce metabolic O2 demand
                                                                                    3. right to left shunt
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