Cyanotic Heart Disease Cardiology With Dr. Brian Alverson Bill Jean, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) 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, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) What Causes a Baby to be Blue? It just the heart! Bill Jean, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) 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, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) 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, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) Truncus arteriosus Transposition of the great arteries Tricuspid atresia Tetralogy of Fallot Total anomalous pulmonary venous return Bill Jean, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) 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, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) 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, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) Truncus arteriosus Transposition of the great arteries Tricuspid atresia Tetralogy of Fallot Total anomalous pulmonary venous return Bill Jean, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) Compared to Transposition of the Great Vessels Pathology High-yield Lecturio GmbH Bill Jean, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) 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, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) Diagnosis Gayathri S, Prasad A, Sachdeva N, Baruah BP, Aggarwal S , https://openi.nlm.nih.gov/detailedresult.php?img=PMC2964806_JPN-5-27Bill Jean, b57981927@outlook.com g001&query=transposition+of+the+great+vessels&it=xg&lic=by&req=4&npos=95, PubMed, CC BY 2.0 © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) Truncus arteriosus Transposition of the great arteries Tricuspid atresia Tetralogy of Fallot Total anomalous pulmonary venous return Bill Jean, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) Tricuspid Atresia Pathology High-yield Normal Heart Lecturio GmbH Bill Jean, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) 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, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) Truncus arteriosus Transposition of the great arteries Tricuspid atresia Tetralogy of Fallot Total anomalous pulmonary venous return Bill Jean, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) 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, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) Tetralogy of Fallot Pathology High-yield Normal Heart Tetralogy of Fallot Lecturio GmbH Bill Jean, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) Tetralogy of Fallot Pathology • Overriding aorta • VSD Lecturio GmbH Bill Jean, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) Tetralogy of Fallot Pathology • Pulmonary stenosis • Right ventricular hypertrophy Lecturio GmbH Bill Jean, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) 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, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) 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, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) 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, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) 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, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) 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, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) Great trick to remember types of cyanotic heart disease Use your hand! Bill Jean, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) 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, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) 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, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) 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, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org) This document is a property of: Bill Jean Note: This document is copyright protected. It may not be copied, reproduced, used, or distributed in any way without the written authorization of Lecturio GmbH. Bill Jean, b57981927@outlook.com © www.lecturio.com | This document is protected by copyright. Powered by TCPDF (www.tcpdf.org)