Tetralogy of Fallot
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Introduction
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Pathophysiology
Four classic features:
- sub pulmonary muscular obstruction/pulmonary stenosis
- aorta shifted to the right
- ventricular septal defect leading to interventricular communication
- concentric right ventricular hypertrophy
Signs and Symptoms
- history
- physical exam
History
One symptom is an increasing cyanosis with crying.
Hypercyanotic (Tet) spells
Acute rise in heart rate (crying, etc) leads to a strng increase in impedance in the pulmonary aretery, leading to increased right-to-left shunt. This leads to a drop in systemic resistance and thereby increased...
Patents are stabilized and admitted to hospital
Physical Exam
Investigations
Differential Diagnosis
Treatments
For acute hypercyanotic spells, (tet spells)
- squatting in older shildren increases systemic vascular resistance; pushing a baby's knees to chest does the same thing.
- oxygen (pulmonary vasodilator)
- fluid bolus (increases preload)
- morphine's sedative effects calm people
- beta blockers, such as propanalol, slow heart rate
- epinephrine
Consequences and Course
Resources and References
Topic Development
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