Cyanosis and hypoxia

Introduction Fallot tetralogy is a common congenital heart vascular malformation, ranking first in purpuric congenital heart disease. The pathological anatomy of the disease has four points: 1 pulmonary stenosis, ventricular septal defect, ascending aortic opening to the right and right ventricular centripetal hypertrophy. The most common major clinical symptoms of tetralogy are purpura and blood hypoxia. The time and severity of presentation of clinical symptoms depends on the extent of right ventricular outflow obstruction and the amount of pulmonary circulation blood flow.

Cause

In 1970, Van Praagh et al considered that the embryonic developmental disorder of tetralogy was due to hypoplasia of the distal segment of the pulmonary artery or the right ventricle. There was no reverse inversion, so the aortic valve remained in the embryonic position, on the right side of the pulmonary valve. The interval of the funnel, that is, the wall bundle should be backward and downward when it is normally developed, while the patient of the quadruple is changed to move forward and backward to the left and stop at the front wall of the cone. The right ventricular outflow tract stenosis occurs after fusion with the heart. At the same time, because the interval of the funnel is forward and upward, the gap between the left front upper branch and the right rear lower branch of the baffle is not occupied above the ventricular septum, so that a huge space is formed at the funnel portion interval, that is, the lower back of the upper chamber. Ventricular septal defect, pulmonary plexus dysplasia caused the aortic opening to move to the right, riding over the ventricular septal defect.

an examination

Related inspection

Blood oxygen content ECG blood pressure

Clinical manifestations:

The most common major clinical symptoms of tetralogy are purpura and blood hypoxia. The time and severity of presentation of clinical symptoms depends on the extent of right ventricular outflow obstruction and the amount of pulmonary circulation blood flow. In the short term after birth, because the arterial catheter has not been closed, the pulmonary circulation blood flow can come from the patent ductus arteriosus, so the clinical appearance often does not present purpura. In most cases, purpura begins to appear after several weeks or months of arterial catheter closure, and gradually worsens. However, if the right ventricular outflow tract obstruction is severe, such as pulmonary atresia, diffuse dysplasia of the outflow tract, and severe stenosis of the funnel, pulmonary valve, and pulmonary valve, purpura may appear after birth. The right ventricular outflow tract obstruction is mild, and the right to left blood flow is less. The degree of purpura is light. If the ventricular level is divided from left to right, the purpura may not be present.

Eating, crying, astringent aggravation during activities, and breathing difficulties. Child patients like to take a squat position. can reduce the venous return flow of the lower extremities, increase the circulation resistance, so that the blood flow in the lungs increases, the arterial oxygen saturation increases, purpura and dyspnea are alleviated. When the funnel is stenosis, the stenosis is aggravated, and a sudden decrease in pulmonary blood flow can cause hypoxic episodes, which may cause difficulty in breathing, fainting, and convulsions. In severe cases, death can occur. It is more prone to attack when the climate is hot and the body temperature rises.

Jet systolic murmurs often weaken or disappear during seizures. Intramuscular injection of morphine 0.2 mg/kg, or propranolol 2.5 mg/kg daily can alleviate hypoxic episodes. In a small number of cases, due to the large ventricular septal defect, the pulmonary vascular resistance decreases from January to February after birth, and the left-to-right sub-flow increases the pulmonary circulation congestion, which may present symptoms of heart failure clinically. But after 6 months of birth, the purpura gradually increased. In cases where the degree of purpura is heavy and red blood cells are significantly increased, thrombosis may occur in the blood vessels of the brain, causing hemiplegia or brain abscess. Cerebral thrombosis is more likely to occur in the absence of water loss. In severe cases of older purpura, the bronchial artery collateral circulation is abundant, and once rupture can cause a large amount of hemoptysis.

Signs:

Physical growth is slower. The face, lips, tongue, and eyelid combined with the membrane are obviously purpura. Children's patients with clubbing (toes) are common. The heart sound zone does not expand, and the left front chest can be raised. The systolic murmur caused by the narrowing of the right ventricular outflow tract can be heard between the 2nd and 3rd ribs of the left sternal border, which may be accompanied by tremor. The degree of stenosis is heavy, the blood flow to the aorta is increased in the right ventricle, and the blood flow in the pulmonary arteries is correspondingly reduced, and the noise is reduced, which is short. The systolic murmur of the pulmonary atresia may disappear and be replaced by a continuous murmur produced by the collateral circulation or patent ductus arteriosus. The second heart sound in the pulmonary valve area is weakened or normal, and sometimes a single loud heart sound from the second heart sound of the aortic valve.

Differential diagnosis

Many hairy congenital heart diseases need to be differentiated from tetralogy of Fallot.

The cyanotic heart malformation that is differentiated from the quadruple syndrome in infancy is:

1 large arterial dislocation, cyanosis occurs after birth, large vascular pedicle narrows, heart larger and pulmonary vascular increase or decrease;

2 tricuspid valve atresia, with characteristic electrocardiogram, the motor axis is more than 30° to the left and left ventricular hypertrophy;

3 single ventricle with pulmonary stenosis;

4 permanent arterial trunk with small pulmonary artery or no pulmonary artery;

5 right ventricle double outlet with pulmonary stenosis.

Clinical manifestations:

The most common major clinical symptoms of tetralogy are purpura and blood hypoxia. The time and severity of presentation of clinical symptoms depends on the extent of right ventricular outflow obstruction and the amount of pulmonary circulation blood flow. In the short term after birth, because the arterial catheter has not been closed, the pulmonary circulation blood flow can come from the patent ductus arteriosus, so the clinical appearance often does not present purpura. In most cases, purpura begins to appear after several weeks or months of arterial catheter closure, and gradually worsens. However, if the right ventricular outflow tract obstruction is severe, such as pulmonary atresia, diffuse dysplasia of the outflow tract, and severe stenosis of the funnel, pulmonary valve, and pulmonary valve, purpura may appear after birth.

The right ventricular outflow tract obstruction is mild, and the right to left blood flow is less. The degree of purpura is light. If the ventricular level is divided from left to right, the purpura may not be present. Eating, crying, astringent aggravation during activities, and breathing difficulties. Child patients like to take a squat position. can reduce the venous return flow of the lower extremities, increase the circulation resistance, so that the blood flow in the lungs increases, the arterial oxygen saturation increases, purpura and dyspnea are alleviated. When the funnel is stenosis, the stenosis is aggravated, and a sudden decrease in pulmonary blood flow can cause hypoxic episodes, which may cause difficulty in breathing, fainting, and convulsions. In severe cases, death can occur. It is more prone to attack when the climate is hot and the body temperature rises.

Jet systolic murmurs often weaken or disappear during seizures. Intramuscular injection of morphine 0.2 mg/kg, or propranolol 2.5 mg/kg daily can alleviate hypoxic episodes. In a small number of cases, due to the large ventricular septal defect, the pulmonary vascular resistance decreases from January to February after birth, and the left-to-right sub-flow increases the pulmonary circulation congestion, which may present symptoms of heart failure clinically. But after 6 months of birth, the purpura gradually increased. In cases where the degree of purpura is heavy and red blood cells are significantly increased, thrombosis may occur in the blood vessels of the brain, causing hemiplegia or brain abscess. Cerebral thrombosis is more likely to occur in the absence of water loss. In severe cases of older purpura, the bronchial artery collateral circulation is abundant, and once rupture can cause a large amount of hemoptysis.

Signs:

Physical growth is slower. The face, lips, tongue, and eyelid combined with the membrane are obviously purpura. Children's patients with clubbing (toes) are common. The heart sound zone does not expand, and the left front chest can be raised. The systolic murmur caused by the narrowing of the right ventricular outflow tract can be heard between the 2nd and 3rd ribs of the left sternal border, which may be accompanied by tremor. The degree of stenosis is heavy, the blood flow to the aorta is increased in the right ventricle, and the blood flow in the pulmonary arteries is correspondingly reduced, and the noise is reduced, which is short. The systolic murmur of the pulmonary atresia may disappear and be replaced by a continuous murmur produced by the collateral circulation or patent ductus arteriosus. The second heart sound in the pulmonary valve area is weakened or normal, and sometimes a single loud heart sound from the second heart sound of the aortic valve.

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