ARJ
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A term male infant is found to be cyanotic shortly after birth and requires endotracheal intubation. On physical examination, his blood pressure is 68/34 mm Hg (equal in all four extremities), pulse is 180/min, and respirations are 32/min. His precordium is dynamic, has a grade III systolic murmur, and a single S2.
Chest radiography shows a normal heart size and increased pulmonary vascular markings. An arterial blood gas on an FiO2 of 100% shows pH 7.34; PaCO2, 47 mm Hg; PaO2, 46 mm Hg. Which of the following diagnoses is most consistent with these findings?
a)Atrial septal defect
b)Hypoplastic left heart syndrome
c)Patent ductus arteriosus
d)Tetralogy of Fallot
e) Total anomalous pulmonary venous return
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| drkpp
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e????? or b?????
ammm i wld go with e..
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| catmd
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I think B - hes got lung findings and charac ABG's. I know hrt size is normal maybe he has'nt develped cardiomegaly yet
ASD r/o by single S2 plus is not cyanotic, nor is PDA and murmer is wrong for that. TOF might have fit picture with murmer plus S2 but TOF is never cyanotic in first 24 hrs. TAPV wd have char radiology. By exclusion - B.
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| phuluong2k
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E
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| nisha
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E.
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| ARJ
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E. Total anomalous pulmonary venous return is characterized by the pulmonary veins forming a confluence behind the left atrium, and draining into the right atrium. Complete mixing takes place in the right atrium, with a right-to-left shunt through the foramen ovale to the left side of the heart. Often, no murmur is heard on cardiac examination, although a short systolic murmur is sometimes heard. ECG often reveals right atrial enlargement and right ventricular hypertrophy. The chest roentgenogram often shows a normal heart size with pulmonary edema. If there is obstruction to pulmonary venous return, as is almost always present with veins draining inferior to the diaphragm, cyanosis can be very prominent. Definitive treatment is surgical anastomosis of the pulmonary vein to the left atrium. Atrial septal defect (ASD) (choice A) is a hole in the septum between the right and the left atria. It results in a left-to-right shunt and causes right ventricular volume overload and increased pulmonary blood flow. Approximately 3% to 5% of children with congenital heart disease have an ASD, making it the third most common congenital heart defect. Hypoplastic left heart syndrome (choice B) is characterized by underdevelopment of the left ventricle and the ascending aorta. Typically, there is obstruction at the mitral valve, causing all pulmonary venous blood to shunt through either an ASD or a patent ductus arteriosus (PDA) into the right atrium. Total systemic blood flow is channelled through the ductus arteriosus from the pulmonary artery. As the ductus closes, these infants present with shock because systemic blood flow is significantly reduced. PDA (choice C) causes symptoms of pulmonary congestion, dyspnea, widened pulse pressure, and bounding arterial pulsation because aortic blood flow is shunted from left to right. Tetralogy of Fallot (choice D) consists of four cardinal cardiac defects: (1) pulmonary stenosis (PS), (2) a large ventricular septal defect (VSD), (3) right ventricular hypertrophy, and (4) aorta overriding the VS
D. The PS causes a harsh systolic murmur easily audible over the upper left sternal border. There is a significant right-to-left shunt because the large VSD allows unrestricted flow from the right ventricle to the left ventricle, causing cyanosis.
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| kabu
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I thought that with TAPV u should see a figure of 8 heart - does that come at a later stage or does it just vary from case to case?
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| webjeee
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why not Tetralogy of Fallot
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