Tetralogy of Fallot Flashcards
What are the 4 pathologies in tetralogy of fallot
VSD, overriding aorta, pulmonary valve stenosis, RV hypertrophy
What is meant by overriding aorta
Aorta valve is placed further to the right than normal above the VSD
What causes the degree of severity in a patient
Most related to the severity of the patients pulmonary stenosis
Overall effect of the pathologies in tetralogy of fallot
Overriding aorta and pulmonary stenosis valve encourage blood flow to be shunted from the right heart to the left, which causes cyanosis. Stenosis causes greater resistance of flow, the RVH causes increased strain and VSD allows blood to flow between the ventricles
Risk factors for tetralogy of fallot
Rubella, increased age of mother, alcohol consumption during pregnancy and diabetic mother
What will show on the CXR of tetralogy of fallot
Boot shaped heart
Presentation of someone with teralogy of fallot
Usually diagnosed on antenatal scans, severe cases of HF before 1 year, can present in older children if less severe.
Murmur in tetralogy of fallot
Ejection systolic murmur, heard loudest over pulmonary area
Symptoms of tetralogy of fallot
Cyanosis, clubbing, poor feeding, poor weight gain, Tet spells, murmur
What are Tet spells
Intermitant symptomatic periods where the right to left shunt becomes temporarily worsened precipitating a cyanotic episode.
What can Tet spells lead to
Unconsciousness, seizures and death
Causes of Tet spells
This happens when a pulmonary vascular resistance increases or the systemic resistance decreases - exercise/exertion
Treatment of Tet spells
Squatting, knees to chest, supplementary oxygen, beta blockers, IV fluids, morphine, sodium bicarb, phenylephrine infusion
Definitive treatment of tetralogy of fallot
Total surgical repair by open heart surgery. VSD is closed, 90% surgery will survive into adulthood
