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Slides Cyanotic Heart Disease

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Cyanotic Heart Disease
Cardiology
With Dr. Brian Alverson
Bill Jean, [email protected]
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Learning Objectives
• During this talk we will first focus on how we approach
a blue baby either right at birth or soon after birth in the
newborn nursery or neonatal intensive care unit
• Then we will individually look at the five major types of
congenital cyanotic heart disease.
Bill Jean, [email protected]
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What Causes a Baby to be Blue?
It
just the heart!
Bill Jean, [email protected]
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If you Suspect a Baby Is Blue, what Do you Do?
Diagnosis
Take a good history
• Age of onset
Do a physical exam
• ABG
• Birth history
• Differences
between arms and
legs?
• Prenatal history
• Lung exam
• CBC
• Cardiac exam
• CXR/EKG/Echo
Bill Jean, [email protected]
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Get labs
• Hyperoxia test
High-yield
The Hyperoxia Test
• 100 % FiO2 for 10 minutes
• Draw an ABG
•
> 200 mmHg: cardiac disease unlikely
•
50 150: suggest mixing lesion (truncus,
tricuspid atresia)
•
< 50: suggests two circuits with mixing (TGA)
Bill Jean, [email protected]
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Truncus arteriosus
Transposition of the great arteries
Tricuspid atresia
Tetralogy of Fallot
Total anomalous pulmonary venous return
Bill Jean, [email protected]
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Truncus Arteriosus
The aorta and
pulmonary
artery have
a common
origin.
VSD allows
blood from
left and right
ventricle to
enter common
artery.
Lecturio GmbH
Bill Jean, [email protected]
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Truncus Arteriosus
Pathology
Truncus
arteriosus
•
A single trunk with a single valve
supplying both pulmonary and
systemic circulation
•
Truncus overrides a VSD, resulting
in a mixing of blue (cyanotic) and
red (oxygenated) blood.
Lecturio GmbH
Bill Jean, [email protected]
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Truncus arteriosus
Transposition of the great arteries
Tricuspid atresia
Tetralogy of Fallot
Total anomalous pulmonary venous return
Bill Jean, [email protected]
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Compared to Transposition of the Great Vessels
Pathology
High-yield
Lecturio GmbH
Bill Jean, [email protected]
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Transposition of the Great Vessels
Pathology
•
The right ventricle goes to the
aorta.
High-yield
•
The left ventricle goes to the
pulmonary artery.
•
The ductus arteriosus/VSD/ASD
keeps the patient alive!
•
It is more common in infants of
diabetic mothers.
Lecturio GmbH
Bill Jean, [email protected]
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Diagnosis
Gayathri S, Prasad
A, Sachdeva
N, Baruah BP, Aggarwal S , https://openi.nlm.nih.gov/detailedresult.php?img=PMC2964806_JPN-5-27Bill Jean,
[email protected]
g001&query=transposition+of+the+great+vessels&it=xg&lic=by&req=4&npos=95,
PubMed, CC BY 2.0
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Truncus arteriosus
Transposition of the great arteries
Tricuspid atresia
Tetralogy of Fallot
Total anomalous pulmonary venous return
Bill Jean, [email protected]
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Tricuspid Atresia
Pathology
High-yield
Normal Heart
Lecturio GmbH
Bill Jean, [email protected]
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Tricuspid Atresia
Tricuspid Atresia
Pathology
•
There is no connection between
the right atrium and right ventricle.
•
The right ventricle is usually very
small.
•
VSD is usually present.
Lecturio GmbH
Bill Jean, [email protected]
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Truncus arteriosus
Transposition of the great arteries
Tricuspid atresia
Tetralogy of Fallot
Total anomalous pulmonary venous return
Bill Jean, [email protected]
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Tetralogy of Fallot
Pathology
•
Tetralogy of Fallot is the most
common cyanotic heart disease.
•
There are four major findings, and
it can look pretty complicated.
•
time.
Lecturio GmbH
Bill Jean, [email protected]
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Tetralogy of Fallot
Pathology
High-yield
Normal Heart
Tetralogy of Fallot
Lecturio GmbH
Bill Jean, [email protected]
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Tetralogy of Fallot
Pathology
•
Overriding aorta
•
VSD
Lecturio GmbH
Bill Jean, [email protected]
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Tetralogy of Fallot
Pathology
•
Pulmonary stenosis
•
Right ventricular hypertrophy
Lecturio GmbH
Bill Jean, [email protected]
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The Fallot
Pathology
Abnormal rotation of the cono-truncal
septum (the top part of the heart) with the
intraventricular septum (bottom part)
Lecturio GmbH
Bill Jean, [email protected]
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Transposition of the Great Vessels
Pathology
•
•
The boot-shaped
appearance of the heart
on CXR
The role of squatting in
increasing peripheral
vascular resistance and
thus decreasing the
magnitude of the right-toleft shunt
Aorta receives
blood from both
ventricles
High-yield
Low oxygen
blood
Hyperthrophy
of right ventricle
Lecturio GmbH
Bill Jean, [email protected]
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Pulmonary
valve
stenosis
Oxygenated
blood
Reduced oxygen
blood flow
Ventricular
septal defect
Truncus arteriosus
Transposition of the great arteries
Tricuspid atresia
Tetralogy of Fallot
Total anomalous pulmonary venous return
Bill Jean, [email protected]
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High-yield
Total Anomalous Pulmonary Venous Return
Pathology
AO
PA
High-yield
LA
LV
RA
RV
Normal Heart
Total anomalous pulmonary venous return
Lecturio GmbH
Bill Jean, [email protected]
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Total Anomalous Pulmonary Venous Return
Pathology
The heart is mostly normal, except blood
coming back from the lungs goes
somewhere totally anomalous
•
Supracardiac (50 %)
•
Infracardiac (20 %)
AO
PA
LV
RA
•
Cardiac (20 %)
•
Mixed (10 %)
usually the RA
High-yield
LA
RV
any of the above
Oxygen-rich blood
Oxygen-poor blood
Mixed blood
Lecturio GmbH
Bill Jean, [email protected]
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Great trick to remember types of
cyanotic heart disease
Use your hand!
Bill Jean, [email protected]
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Clinical pearl
Questions on Cyanotic Heart Disease
Name the 5 types of cyanotic heart disease
A. Truncus arteriosus
B. Transposition of the great arteries
C. Tricuspid atresia
D. Tetralogy of Fallot
E. Total anomalous pulmonary venous return
Bill Jean, [email protected]
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Questions on Cyanotic Heart Disease
What finding in Tetralogy of Fallot most directly affects whether a child is a
tet
tet
A. Overriding aorta
B. VSD
C. Pulmonary artery stenosis
D. RVH
Bill Jean, [email protected]
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Questions on Cyanotic Heart Disease
What is the first med you give a baby with cyanotic heart disease?
A. Epinephrine drip
B. Bicarb infusion
C. Prostaglandins
D. Surfactant
Bill Jean, [email protected]
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Bill Jean, [email protected]
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