L5: Cyanotic CHD Flashcards
(91 cards)
1
Q
Def of Cyanosis
A
It is bluish discoloration of skin and mucus membranes.
2
Q
When Does Clinical Cyanosis Present?
A
3
Q
Cyanosis is recognized at …..
A
- Higher levels of SaO2 ⇢ in patients with polycythemia.
- Lower levels of SaO2 ⇢ in patients with anemia
4
Q
Etiology of Cyanosis
A
- Central
- Peripheral
- Methemoglobinemia
5
Q
Etiology of Cyanosis
- Central
A
6
Q
Cental Causes of Cyanosis
- Cardiac
A
7
Q
Cental Causes of Cyanosis
- Pulmonary
A
◈ Obstruction of the airway
◈ Parenchymatous lung disease (e.g. pneumonia)
◈ Weakness of the respiratory muscles
8
Q
Cental Causes of Cyanosis
- CNS
A
Central nervous system depression
9
Q
Causes of Cyanosis
- Peripheral
A
“⇡⇡ extraction of oxygen by tissues.”
10
Q
Causes of Cyanosis
- Methemoglobinemia
A
“Hemoglobinopathies
11
Q
INVx for Cyanosis
A
12
Q
INVx for Cyanosis
- Hyperoxia Test
A
13
Q
Consequences of Cyanosis
A
14
Q
Polycythemia in Cyanosis
- Pathogenesis
A
15
Q
Polycythemia in Cyanosis
- Effects
A
16
Q
Clubbing in Cyanosis
- Pathogenesis
A
◈ It results from soft tissue proliferation at the base of nail beds 2ry to chronic hypoxemia.
◈ It appears when the duration of central cyanosis > 6 months.
17
Q
Clubbing in Cyanosis
- Site & Grades
A
18
Q
Hypoxic “Hypercyanotic” in Cyanosis
- Incidence
A
◈ Common in 1st 6 months of life & decrease after 1st 2 years.
◈ Common in early morning.
19
Q
Hypoxic “Hypercyanotic” in Cyanosis
- Provoked By
A
Feeding, crying & straining.
20
Q
Hypoxic “Hypercyanotic” in Cyanosis
- Mechanism
A
21
Q
Hypoxic “Hypercyanotic” in Cyanosis
- CP
A
22
Q
Hypoxic “Hypercyanotic” in Cyanosis
- TTT
A
23
Q
Squatting in Cyanosis
- Cause
A
- Seen in children with right-to-left shunt (e.g., TOF) to increase arterial oxygen saturation
24
Q
Squatting in Cyanosis
- Effect
A
25
**CNS Complications in Cyanosis**
26
**Brain Abcess in Cyanosis**
- Cause
27
**CVT in Cyanosis**
- Site
- Incidence
- CP
28
**Arterial Ischemic Stroke in Cyanosis**
- Causes
- Caused by embolization of a thrombus in the cardiac chamber or in the systemic veins.
29
**Bleeding Disorders in Cyanosis**
- Causes
◈ Thrombocytopenia and defective platelet aggregation
◈ Consumption coagulopathy with prolonged PT & APTT
◈ Decreased levels of fibrinogen and factors V and VIII
30
**Bleeding Disorders in Cyanosis**
- CP
- Easy bruising,
- petechiae of skin & MM
- epistaxis
- gingival bleeding
31
**Bleeding Disorders in Cyanosis**
- TTT
Red cell withdrawal and replacement with equal volume of plasma
32
**Low IQ in Cyanosis**
- Children with cyanosis and chronic hypoxia have lower than expected intelligent quotient, poorer perceptual and gross motor function than children with acyanotic CHDs
33
**Scoliosis in Cyanosis**
Children with chronic cyanosis, particularly girls with TOF may have scoliosis
34
Incidence of **TOF**
The most common congenital cyanotic heart disease.
35
Pathology of **TOF**
36
Pathology of **TOF**
- The more the infundibular septum is displaced anteriorly, ......
37
Associated Anomalies to **TOF**
38
Associated Anomalies to **TOF**
- Coronary Arteries
39
Associated Anomalies to **TOF**
- PS
(sub valvular / valvular).
40
Associated Anomalies to **TOF**
- Aortic Arch
aortic arch is right sided in 20% of cases with TOF.
41
Associated Anomalies to **TOF**
- Venous Abnormalities
(TAPVR, PAPVR)
◈ Persistent left SVC drains into coronary sinus.
◈ Intrahepatic interruption of IVC with azygous continuation,
42
Associated Anomalies to **TOF**
- PDA
...
43
Phsyiology of **TOF**
44
Phsyiology of **TOF**
- The magnitude and direction of the shunt are determined by
45
Phsyiology of **TOF**
- Mild PS
46
Phsyiology of **TOF**
- Moderate PS
47
Phsyiology of **TOF**
- Severe PS
48
Phsyiology of **TOF**
- Cyanosis will increase in the following conditions:
49
Phsyiology of **TOF**
◈ If the shunt is left to right ⇢
◈ If the shunt is balanced ⇢
◈ If the right to left ⇢
50
◈ However, mild to moderate neonatal cyanosis tends to increase.
◈ By 5-8 years of age the majority of children are cyanotic and symptomatic.
....
51
CP of **TOF**
52
CP of **TOF**
- Hx
◈ Cyanosis
◈ Dyspnea on exertion
◈ Squatting
◈ Hypoxic spell
53
CP of **TOF**
- General Ex
- Central cyanosis “Mostly delayed to 2nd month”
- Blue clubbing “After 6 months”
- Squatting position
54
CP of **TOF**
- Local Ex
55
CP of **TOF**
- Inspection & Palpation
56
CP of **TOF**
- Apex
57
CP of **TOF**
- Auscultation
58
CP of **TOF**
- Heart Sounds
59
CP of **TOF**
- Murmur
60
INVx in **TOF**
61
INVx in **TOF**
- Chest X-Ray
62
INVx in **TOF**
- ECG
◈ Right axis deviation
◈ Right ventricular hypertrophy
63
INVx in **TOF**
- ECHO
64
Complications of **TOF**
65
Complications of **TOF**
- Hypoxic Spells
in infant less than 2 years
66
Complications of **TOF**
- Hematologic Abnormalities
67
Complications of **TOF**
- Infective endocarditis
Occurs on
- stenotic pulmonary valve
- thickened tricuspid valve
68
Complications of **TOF**
- CNS Complications
- Brain abscess in older children.
- Arterial ischemic strokes
- Cerebral venous thrombosis in infants < 2 years.
- Cerebrovascular accidents as hemorrhage
69
Management of **TOF**
70
Management of **TOF**
- Medical
71
Medical Management of **TOF**
- 1st Thing to do
Give PGE1
72
Medical Management of **TOF**
- Oral Iron
To prevent anemia
73
Medical Management of **TOF**
- Oral Propranolol
74
Medical Management of **TOF**
- Phlebotomy & Plasma Replacemet
⇢ For patients with high hematocrit
⇢ Prior to surgery in case of coagulation abnormalities
75
Medical Management of **TOF**
- IE Prophylaxis
...
76
Medical Management of **TOF**
- TTT of Hypercyanotic Spells
If present
“As mentioned before”
77
Surgical Management of **TOF**
78
Incidence of **TGA**
The most common congenital cyanotic heart disease in newborns.
79
Pathology in **TGA**
80
CP of **TGA**
81
CP of **TGA**
- General Ex
82
CP of **TGA**
- Auscultation
83
CP of **TGA**
- Heart Sounds
S2 ⇢ single, loud
84
CP of **TGA**
- murmur
No heart murmur is heard in infants with an intact ventricular septum.
- If associated with VSD ⇢ Pan systolic murmur
- If associated with PS ⇢ Ejection systolic murmur
85
INVx of **TGA**
86
INVx of **TGA**
- Chest X-Ray
87
INVx of **TGA**
- Others
Same as in TOF
+
ECG, ECHO, Pulse oximetry & ABG, CBC, Cardiac catheterization “Angiography”
88
Management of **TGA**
89
Management of **TGA**
- Medical
◈ Prostaglandin El infusion to improve arterial oxygen saturation by reopening the ductus.
◈ If associated with CHF may be treated with
- ACE
- Diuretics
- Digoxin.
90
Management of **TGA**
- Cardiac Cathetrization
Balloon atrial septostomy to ensure adequate intracardiac mixing.
91
Management of **TGA**
- Surgical
