Fallot’s Tetralogy Clinical features Symptoms Complications WITH Treatment

Fallot’s Tetralogy ClinicalPeptic Ulcer Causes Examination Diagnosis and Treatment. Read more ... » features of Fallot’s Tetralogy SymptomsPeptic Ulcer Causes Examination Diagnosis and Treatment. Read more ... » Complications WITH TreatmentPeptic Ulcer Causes Examination Diagnosis and Treatment. Read more ... »

Fallot's Tetralogy Clinical features

Fallot’s Tetralogy Symptoms Complications WITH Treatment

Clinical featuresPulmonary Thromboembolism Pathophysiology Clinical Features with Treatment. Read more ... » of Fallot’s Tetralogy

Symptoms are progressive due to :

Physical examinationHow to take good medical history & examination. Read more ... »

Hypoxic spells  :

  • Child becomes blue, weak and limp.
  • There is dysp­noea, syncope and tachypnea.
  • Hypoxic spells are seen commonly at the age of 2-3 years.
  • Child is restless, irri­table and cyanosed. Eyes roll back.
  • Sometimes there is generalized stiffness or convul­sions.
  • Spell lasts 5 – 10 minutes. Oxygen saturation becomes low Systolic murmur disappears
  • Episodes are most common in the morning . Precipitating factors are:
  • · crying, sucking, defecating, hot weather, infec­tion, exercise, standing, tachycardiaHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... ».
  • · hypoxic spells may occur several times a day or once a month.

Cause of Hypoxic Spells:

Squatting:

  • More common in children
  • Squatting occurs because patient can relieve his dys­pnoea and prevent syncope.
  • Squatting reduces right-to-Ieft shunt and increases saturation of mixed venous blood by :
  • · Squatting increases arterial oxygen saturation when patient squats or rests after exercise.
  • Children with Fallot’s tetralogy avoid hanging their limbs and always sit with legs tucked under their body or lie in a knee-chest or lateral position with the legs drawn up
  • · Increasing peripheral resistance
  • · Trapping venous blood of low oxygen saturation in the lower limbs
  • · Decreasing hydrostatic pooling.
  • On examination heart is not enlarged. There is no precordial prominence.
  • No parasternal heave. There is no LVH.
  • A systolic murmur is maximal in the second and third intercostals spaces at the left sternal border and var­ies in duration and configuration depending on the severity of the pulmonary stenosis. The ventricular septal defect is apparently silent.
  • In mild Tetralogy a grade 3-4 systolic murmur ex­tends into the aortic component of the S2.
  • If P2 is audible then pulmonary stenosis is not se­vere.
  • In valvular pulmonary stenosis, a pulmonary ejection sound is found. A2 is loud.
  • In severe Tetralogy, murmur is short, soft and early systolic.
  • A2 is loud and P2 inaudible.
  • Aortic ejection sound is heard at the left sternal bor­der and apex.
  • A continuous murmur of pulmonary collateral circula­tion is heard in pulmonary atresia with ventricular septal defect.

ECGAcute Myocardial Infarction (AMI) Causes PATHOPHYSIOLOGY and Etiology. Read more ... »

  • Shows right ventricular enlargement and right atrial hypertrophy.

X-ray

  • Shows boot-shaped heart (Coeur en sabot) due to right ventricular hypertrophy, and concave pulmonary conus.
  • Pulmonary vascular markings are faint and aortic arch and aortic knob may be seen on the right side.

2D echocardiography2D Echocardiography Dobutamine Stress Echocardiography. Read more ... »

  • Shows overriding of aorta, pulmonary stenosis and right ventricular hypertrophy.

Complications of Fallot’s Tetralogy

Treatment of Fallot’s Tetralogy

  • Corrective surgery is done after evaluation of the pulmonary vascular systemPeptic Ulcer Causes Examination Diagnosis and Treatment. Read more ... ».
  • If there is pulmonary atresia, then full correction is deferred and a palliative operation is done i.e. cre­ation of a systemic pulmonary arterial shunt.
  • The later the corrective surgery is done the lower the risk. But an early corrective surgery prevents pro­gressive obstruction of the pulmonary outflow tract, prevents growth impairment, and complications due to hypoxemia, erythrocytosis.

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