15.2.1.1 Cyanotic Cardiac

Question 1

Cyanosis

Answer 1

• Blue
• Clubbing
• hypoxaemia
• decreased saturations

Question 2

Define Cyanosis

Answer 2

• Cyanosis is a blue discolouration of the skin and mucous membrane sassociated with poor oxygenation.
• Noticeable when >5g/dl of deoxygenated hemoglobin present
• Assessed by pulse oximetry
• Peripheral cyanosis
• Central
• Differential cyanosis
• Reversed differential cyanosis

Question 3

Differentiation of cyanosis

Answer 3

Peripheral cyanosis
- cold
- SATS will be normal
- pink tongue
- cap refill >2 sec

Central cyanosis
- indication of cardiac defect
- discoloration all skin and mucous
- decreased PaO2, SpO2
- cap refill <2sec
- pulmonary and CNS disease

Slide 15

Question 4

DIFFERENTIAL AND REVERSED DIFFERENTIAL CYANOSIS

Answer 4

Differential:
- Lower limb sats < upper limb
- open ductus
- deO2 flowing into lower body
- persistent pulmonary hypertension

Reverse
- Upper limb sats < lower limb
- open duct and open duct

Check this

Question 5

Duct dependant cardiac lesions

Answer 5

• Congenital cardiac abnormality: duct critical for vital circulation
• Any neonate with sudden onset cyanosis/shock – duct dependent lesion until proven otherwise
• PGE to maintain duct patency could be life-saving
• IV or oral

Question 6

Decreased pulmonary blood flow

Answer 6

Tetralogy of Fallot
- pulmonary stenosis (severe right ventricular outflow stenosis)
- VSD
- overrying aorta
- right ventricular hypertrophy
- aorta moved over and turned a bit
- movement of septum and coronary artery
- sub pulmonary obstruction -> RV pump a lot harder
- get different degree {slide 23}

Pulmonary atresia
- don’t have pulmonary valve
- small pulmonary arteries

Tricuspid atresia
- don’t have tricuspid valve {slide 25}
- can present in many different ways
- child is blue + left axis deviation
- do not have to know the 9 different types

Question 7

Mixers (Increased pulmonary blood flow)

Answer 7

• Transposition of the great arteries
• Truncus Arteriosus
• TAPVD

Question 8

TRANSPOSITION OF THE GREAT ARTERIES

Answer 8

• left heart and right heart have no connection and don’t pump together
• only way that child gets O2 blood is through ductus
• lower limbs gets good blood, but brain and upper body don’t get enough blood

Question 9

TRUNCUS ARTERIOSUS

Answer 9

• only one outflow of heart
• high pressures in both ventricles

Question 10

TAPVD

Answer 10

• total … pulmonary venous drainage
• right heart will be massive