HYPERCYANOTIC HEART DISEASE

Question 1

Hypercyanotic heart disease occurs in infants with a peak incidence between …………

Answer 1

4 and 6 months

Question 2

Complications of hypercyanotic heart attack

Answer 2

Limpness
Seizure
Cerebrovascular accident
Death

Question 3

Which time of the day does hypercyanotic heart attack usually occur

Answer 3

Morning

Question 4

Precipitants of hypercyanotic heart attack

Answer 4

Bathing
Defaecation
Febrile illness
Induction of anaethesia
Prolonged crying

Question 5

Causes of hypercyanotic heart attack

Answer 5

Congenital heart disease

Question 6

Symptoms of hypercyanotic attack

Answer 6

Irritability
Prolonged crying
Deep rapid breathing
Increased severity of cyanosis

Question 7

Signs of hypercyanotic attack

Answer 7

Tachycardia
Systolic murmur
Coma
Convulsions
Hemiparesis

Question 8

Investigations in hypercyanotic heart attack

Answer 8

FBC
ECG
Echocardiography
Chest X-ray

Question 9

Treatment objectives of hypercyanotic attack

Answer 9

Early recognition of the problem
Reverse obstruction
Correct metabolic derangement in severe hypoxia
Prevent complications and death from severe hypoxia

Question 10

Non-pharmacological interventions in hypercyanotic attack

Answer 10

Hold in knee chest position to increase peripheral resistance and reduce cyanosis

Question 11

Initial pharmacological treatment of hypercyanotic heart attack

Answer 11

Oxygen 2L/min
and
R/L or N/S IV 10ml/kg over 30 mins
and
Morphine sulphate IV/IM 100-200mcg/kg stat

Question 12

If patient has poor response to oxygen, hydration and morphine, what is the next option

Answer 12

Propranolol
Children 1 month-12 years
500 microgram/kg 8 hourly (max. 5 mg/kg daily)
Neonates
500 microgram/kg 8 hourly (max. 2 mg/kg 8 hourly)

Question 13

When is treatment for acidosis required in hypercyanotic attack

Answer 13

When patient is proving after 10mins of propranolol and initial treatment

Question 14

Treatment of acidosis in hypercyanotic attack

Answer 14

Sodium bicarbonate 1-2mmol/Kg

Question 15

Maintenace treatment of hypercyanotic attack to prevent recurrence attacks pending surgery

Answer 15

Propranolol, oral,
Children 1 month-12 years
0.25-1 mg/kg 6-8 hourly (max. 5 mg/kg daily)
Neonates
0.25-1 mg/kg 8-12 hourly (max. 2 mg/kg 8 hourly)

Propranolol, slow IV with ECG monitoring,
Children 1 month-12 years
15-20 microgram/kg 6-8 hourly (max. 200 microgram/kg) repeated
every 6-8 hours if necessary
Neonates
15-20 microgram/kg (max. 100 microgram/kg) repeated every 12
hours if necessary