congenital heart disease
CC6 Cardiology MRCEM syllabus / NeoC3 Neonatal emergencies MRCEM
essentially the problem is:
- Not enough pulmonary blood flow → they are blue
- Too much pulmonary blood flow → pink
- Not enough systemic blood flow → grey
- Not enough coronary artery blood flow
| Cyanotic (implies R→L shunt) | Acyanotic (L→R shunt) |
|---|---|
| - tetralogy of Fallot - TGA - TV/pulmonary atresia - TAPVD (Total anomalous pulmonary venous drainage) - pulm veins - hypoplastic L heart syndrome - truncus arteriosus |
- ASD - VSD - PDA - coarctation of aorta |
clinical presentation
left to right shunt
'Tet spell'
- systemic vascular resistance ↓ e.g. from crying
- ↑ shunting from right to left side
- ↓ pO2, ↑ CO2 → hypoxic vasoconstriction in lungs
- ↑ venous return... which ↑ shunting!
BREAK THE CYCLE:
- calm everyone down (you, the patient and the parent)
- ↑ systemic vascular resistance = knees to chest
- ↓ pulmonary vascular resistance = high flow oxygen
- ↓ venous return