Congenital cyanotic heart disease: Difference between revisions
No edit summary |
No edit summary |
||
Line 4: | Line 4: | ||
== Overview == | == Overview == | ||
Congenital cyanotic heart disease is a group of heart defects that will causes neonatal cyanosis. The patient appears blue ([[Cyanosis|cyanotic]]), due to deoxygenated [[blood]] bypassing the [[Lung|lungs]] and entering the [[systemic circulation]]. This can be caused by [[Right-to-left shunt|right-to-left]] or [[Bidirectional shunt|bidirectional]] [[Shunt (medical)|shunting]], or malposition of the [[great arteries]]. Such defects include [[persistent truncus arteriosus]], [[total anomalous pulmonary venous connection]], [[tetralogy of Fallot]], [[transposition of the great vessels]], and [[Ebstein's anomaly]]. | |||
== Classification == | == Classification == | ||
Congenital cyanotic heart disease may be classified according to anatomical defect into 5 subgroups: | |||
== | * Tetralogy of fallot | ||
**It is understood that tetralogy of fallot is the result of improper positioning of the outlet [[septum]]. | |||
**In the normal [[heart]], the outlet septum is an indistinguishable component of the crista supraventricularis that communicates with the [[Septomarginal trabecula|septomarginal trabeculae]] to divide the [[Right ventricle|right]] and [[Left ventricle|left]] [[Ventricle|ventricular cavities]]. | |||
**In Tetralogy of Fallot, proper [[Ventricle (heart)|ventricular]] septation is perturbed by anterocephalad displacement of the outlet [[Septum (disambiguation)|septum]] relative to the [[septomarginal trabecula]]. | |||
**The direct consequence of this misalignment is an [[Overriding aorta|overriding aortic orifice]] and a [[ventricular septal defect]], resulting in an intracardiac [[Right-to-left shunt|right to left shunt]] of blood. | |||
**In addition, anterocephalad displacement of the outlet septum indirectly predisposes the [[pulmonary trunk]] to [[Pulmonary stenosis|stenosis]] in the setting of septoparietal trabecular [[hypertrophy]]. | |||
**Together, the displacement of the outlet [[septum]] coupled with the [[Hypertrophy (medical)|hypertrophic]] arrangement of the septoparietal trabeculae account for the three [[Anatomy|anatomical]] cardinal [[Defect|defects]] in Tetralogy of Fallot - [[Aorta|aortic]] dextroposition, [[Ventricular septal defect|interventricular communication]] ([[VSD]]), and [[pulmonary stenosis]]. | |||
**The fourth [[defect]] - [[right ventricular hypertrophy]] - is a [[hemodynamic]] consequence of these three [[Morphology|morphologic]] changes, as the [[right ventricle]] physiologically adapts to the increased [[resistance]] of a [[Pulmonary stenosis|stenotic pulmonary trunk]]. | |||
* Total anomalous pulmonary venous connection | |||
**n this condition,the right side of heart is receiving blood both from pulmonary and systemic circulation. | |||
**There is a mixing of oxygenated pulmonary venous blood with deoxygenated blood from systemic circulation. | |||
** The mixing of blood could occur at three levels i.e. supracardiac, infracardiac and cardiac. | |||
**In the former two the mixing occurs outside the heart and in latter inside the heart (right atrium) | |||
* Transposition of the great arteries | |||
**In the TGA the [[aorta]] arises from the morphologic [[right ventricle]] via a subaortic infundibulum and the [[pulmonary artery]] arises from the morphologic [[left ventricle]], without a subpulmonary infundibulum.<ref name="pmid17159076">{{cite journal |vauthors=Warnes CA |title=Transposition of the great arteries |journal=Circulation |volume=114 |issue=24 |pages=2699–709 |date=December 2006 |pmid=17159076 |doi=10.1161/CIRCULATIONAHA.105.592352 |url=}}</ref><ref name="Levin1977">{{cite journal|last1=Levin|first1=Daniel L.|title=d-Transposition of the Great Vessels in the Neonate|journal=Archives of Internal Medicine|volume=137|issue=10|year=1977|pages=1421|issn=0003-9926|doi=10.1001/archinte.1977.03630220061015}}</ref><ref name="Rashkind1966">{{cite journal|last1=Rashkind|first1=William J.|title=Creation of an Atrial Septal Defect Without Thoracotomy|journal=JAMA|volume=196|issue=11|year=1966|pages=991|issn=0098-7484|doi=10.1001/jama.1966.03100240125026}}</ref><ref name="pmid10569681">{{cite journal |vauthors=Hornung TS, Bernard EJ, Celermajer DS, Jaeggi E, Howman-Giles RB, Chard RB, Hawker RE |title=Right ventricular dysfunction in congenitally corrected transposition of the great arteries |journal=Am. J. Cardiol. |volume=84 |issue=9 |pages=1116–9, A10 |date=November 1999 |pmid=10569681 |doi=10.1016/s0002-9149(99)00516-0 |url=}}</ref> | |||
**These ventriculoarterial connection is known as ventriculoarterial discordance. | |||
**As a consequence, there is a a fibrous continuity between the mitral and [[pulmonary valve]], but no continuity between the [[tricuspid]] and [[aortic valve]]. | |||
**The abnormal origin of the great arteries results in an altered spiral relationship. | |||
**Therefore, the aorta and pulmonary artery run parallel to each other | |||
**In normal heart thus the circulation is in series. | |||
**However, in transposition of the great vessels circulation is in parallel | |||
* Truncus arteriosus | |||
**In truncus arteriosus, the pulmonary arteries are connected to the aorta. | |||
**A decrease in PVR at birth causes a left to right shunt with evidence of congestive heart failure. | |||
**These patients have a very high incidence of pulmonary hypertension and vascular disease. | |||
* Ebstein's anomaly | |||
**[[Pathophysiology]] mainly involves the [[right ventricle]], [[right atrium]] and [[Tricuspid valves|tricuspid valve]]: <ref name="pmid27541719">{{cite journal |vauthors=Kloesel B, DiNardo JA, Body SC |title=Cardiac Embryology and Molecular Mechanisms of Congenital Heart Disease: A Primer for Anesthesiologists |journal=Anesth. Analg. |volume=123 |issue=3 |pages=551–69 |date=September 2016 |pmid=27541719 |pmc=4996372 |doi=10.1213/ANE.0000000000001451 |url=}}</ref><ref name="pmid21127202">{{cite journal |vauthors=Postma AV, van Engelen K, van de Meerakker J, Rahman T, Probst S, Baars MJ, Bauer U, Pickardt T, Sperling SR, Berger F, Moorman AF, Mulder BJ, Thierfelder L, Keavney B, Goodship J, Klaassen S |title=Mutations in the sarcomere gene MYH7 in Ebstein anomaly |journal=Circ Cardiovasc Genet |volume=4 |issue=1 |pages=43–50 |date=February 2011 |pmid=21127202 |doi=10.1161/CIRCGENETICS.110.957985 |url=}}</ref><ref name="pmid23956225">{{cite journal |vauthors=Bettinelli AL, Mulder TJ, Funke BH, Lafferty KA, Longo SA, Niyazov DM |title=Familial ebstein anomaly, left ventricular hypertrabeculation, and ventricular septal defect associated with a MYH7 mutation |journal=Am. J. Med. Genet. A |volume=161A |issue=12 |pages=3187–90 |date=December 2013 |pmid=23956225 |doi=10.1002/ajmg.a.36182 |url=}}</ref><ref name="pmid31384377">{{cite journal |vauthors=Holst KA, Connolly HM, Dearani JA |title=Ebstein's Anomaly |journal=Methodist Debakey Cardiovasc J |volume=15 |issue=2 |pages=138–144 |date=2019 |pmid=31384377 |pmc=6668741 |doi=10.14797/mdcj-15-2-138 |url=}}</ref> | |||
*** Failure of TV([[Tricuspid valves|tricuspid valve]]) leaflet delamination | |||
*** Apical descent of the functional [[Tricuspid|tricuspid orifice]] | |||
*** [[Right ventricular dilation]] and “atrialization” | |||
*** Anterior leaflet abnormal [[fenestrations]] and tethering | |||
*** [[Right atrioventricular orifice|Right atrioventricular junction]] dilation | |||
== Differential diagnosis == | == Differential diagnosis == | ||
Line 44: | Line 77: | ||
! rowspan="20" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary disease|Pulmonary diseases]] | ! rowspan="20" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary disease|Pulmonary diseases]] | ||
! rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Airway]] disorder | ! rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Airway]] disorder | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Severe [[croup]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Severe [[croup]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 63: | Line 96: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Intercostal]] and [[subcostal]] [[retraction]], [[Barking cough]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Intercostal]] and [[subcostal]] [[retraction]], [[Barking cough]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Epiglottitis]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Epiglottitis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 82: | Line 115: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Muffled voice, [[Drooling]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Muffled voice, [[Drooling]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Foreign body aspiration]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Foreign body aspiration]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 101: | Line 134: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Mediastinitis]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Mediastinitis]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Bacterial tracheitis]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Bacterial tracheitis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 120: | Line 153: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Brassy [[cough]], [[Hoarseness]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Brassy [[cough]], [[Hoarseness]] | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Sleep apnea]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Sleep apnea]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 139: | Line 172: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Nightmares]], [[Snoring]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Nightmares]], [[Snoring]] | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Chronic [[bronchitis]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Chronic [[bronchitis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 158: | Line 191: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Productive cough]], [[Chest tightness]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Productive cough]], [[Chest tightness]] | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Atelectasis]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Atelectasis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 178: | Line 211: | ||
|- | |- | ||
! rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Parenchymal lung disease|Parenchymal disorder]] | ! rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Parenchymal lung disease|Parenchymal disorder]] | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Alveolitis]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Alveolitis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/- | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/- | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 197: | Line 230: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Malaise]], [[Chills]], [[Headache]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Malaise]], [[Chills]], [[Headache]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pneumonia]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pneumonia]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 216: | Line 249: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tachycardia]], [[Bradycardia]] ([[Legionella]]) | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tachycardia]], [[Bradycardia]] ([[Legionella]]) | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Asthma]] (Late) | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Asthma]] (Late) | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 235: | Line 268: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Triad of [[asthma]], [[nasal polyps]], and [[rash]] is indicative of [[Aspirin desensitization|aspirin sensitivity]]. | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Triad of [[asthma]], [[nasal polyps]], and [[rash]] is indicative of [[Aspirin desensitization|aspirin sensitivity]]. | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cystic fibrosis]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cystic fibrosis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 255: | Line 288: | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[COPD]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[COPD]] | ||
(Severe [[emphysema]]) | (Severe [[emphysema]]) | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 274: | Line 307: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Pulmonary hypertension]], [[Right heart failure]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Pulmonary hypertension]], [[Right heart failure]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Tuberculosis]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Tuberculosis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 293: | Line 326: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Loss of appetite]], [[Night sweats]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Loss of appetite]], [[Night sweats]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary fibrosis]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary fibrosis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 314: | Line 347: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fatigue]], [[Weight loss]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fatigue]], [[Weight loss]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pneumoconiosis]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pneumoconiosis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 335: | Line 368: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Tightness in the [[chest]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Tightness in the [[chest]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Lung cancer]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Lung cancer]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 358: | Line 391: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Weight loss]], [[Loss of appetite]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Weight loss]], [[Loss of appetite]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acute respiratory distress syndrome]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acute respiratory distress syndrome]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 378: | Line 411: | ||
|- | |- | ||
! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary vascular congestion|Pulmonary vascular disorders]] | ! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary vascular congestion|Pulmonary vascular disorders]] | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Massive [[pulmonary embolism]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Massive [[pulmonary embolism]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 397: | Line 430: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tachycardia]], [[Shock]], [[Pulmonary hypertension]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tachycardia]], [[Shock]], [[Pulmonary hypertension]] | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary arterio-venous malformation]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary arterio-venous malformation]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 416: | Line 449: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cerebral arteriovenous malformation]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cerebral arteriovenous malformation]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary hypertension]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary hypertension]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 438: | Line 471: | ||
|- | |- | ||
! colspan="2" rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Chest wall deformities|Chest wall disorders]] | ! colspan="2" rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Chest wall deformities|Chest wall disorders]] | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Flail chest]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Flail chest]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 457: | Line 490: | ||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Bruises]] over [[chest]] | ! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Bruises]] over [[chest]] | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pneumothorax]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pneumothorax]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 497: | Line 530: | ||
! rowspan="15" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cardiac disease|Cardiac diseases]] | ! rowspan="15" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cardiac disease|Cardiac diseases]] | ||
! rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Congenital disorder|Congenital disorders]] | ! rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Congenital disorder|Congenital disorders]] | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Atrioventricular canal defect (patient information)|Atrioventricular canal defect]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Atrioventricular canal defect (patient information)|Atrioventricular canal defect]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/- | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/- | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 516: | Line 549: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tachypnea]], Lack of [[appetite]], [[Pale skin color]], Excessive [[sweating]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tachypnea]], Lack of [[appetite]], [[Pale skin color]], Excessive [[sweating]] | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ebstein anomaly]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ebstein anomaly]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 535: | Line 568: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fatigue]], [[Palpitations]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fatigue]], [[Palpitations]] | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Tetralogy of Fallot]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Tetralogy of Fallot]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 554: | Line 587: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fainting]], [[Palpitation]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fainting]], [[Palpitation]] | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonic stenosis]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonic stenosis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 573: | Line 606: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fainting]], [[Palpitation]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fainting]], [[Palpitation]] | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Total anomalous pulmonary venous drainage|Total anomalous pulmonary]] [[Total anomalous pulmonary venous drainage|venous connection]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Total anomalous pulmonary venous drainage|Total anomalous pulmonary]] [[Total anomalous pulmonary venous drainage|venous connection]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 592: | Line 625: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Pounding [[heart]], Weak [[pulse]], Extreme [[sleepiness]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Pounding [[heart]], Weak [[pulse]], Extreme [[sleepiness]] | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Transposition of the great vessels]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Transposition of the great vessels]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 611: | Line 644: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Lack of appetite]], [[Poor weight gain]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Lack of appetite]], [[Poor weight gain]] | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Truncus arteriosus]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Truncus arteriosus]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 630: | Line 663: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fatigue]], [[Sweating]], [[Pale skin|Pale]] or cool [[skin]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fatigue]], [[Sweating]], [[Pale skin|Pale]] or cool [[skin]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Patent ductus arteriosus]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Patent ductus arteriosus]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 650: | Line 683: | ||
|- | |- | ||
! rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acquired disorder|Acquired disorders]] | ! rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acquired disorder|Acquired disorders]] | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Heart failure]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Heart failure]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 669: | Line 702: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Generalized edema]], [[Hepatomegaly]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Generalized edema]], [[Hepatomegaly]] | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Valvular heart disease]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Valvular heart disease]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 688: | Line 721: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Syncope]], [[Palpitation]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Syncope]], [[Palpitation]] | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Myocardial infarction]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Myocardial infarction]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 707: | Line 740: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Dizziness]], [[Fatigue]], [[Lightheadedness]], [[Cold sweat]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Dizziness]], [[Fatigue]], [[Lightheadedness]], [[Cold sweat]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cardiogenic shock]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cardiogenic shock]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/- | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/- | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 726: | Line 759: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tachypnea]], [[Palpitation]], [[Hypotension]], Weak [[pulse]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tachypnea]], [[Palpitation]], [[Hypotension]], Weak [[pulse]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cardiomyopathy]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cardiomyopathy]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 745: | Line 778: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Arrhythmias|Arrhythmia]], [[Bloating]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Arrhythmias|Arrhythmia]], [[Bloating]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Heart tumors]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Heart tumors]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 764: | Line 797: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Syncope]], [[Weight loss]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Syncope]], [[Weight loss]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mitral Stenosis]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mitral Stenosis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 785: | Line 818: | ||
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Vascular disease]] | ! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Vascular disease]] | ||
! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Arterial Insufficiency|Arterial disorders]] | ! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Arterial Insufficiency|Arterial disorders]] | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ddx:Acrocyanosis|Acrocyanosis]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ddx:Acrocyanosis|Acrocyanosis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 804: | Line 837: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Brittle nails]], [[Telangiectasia]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Brittle nails]], [[Telangiectasia]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Arterial embolism]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Arterial embolism]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 823: | Line 856: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Headache]], Decreased [[sensation]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Headache]], Decreased [[sensation]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Raynaud's Phenomenon]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Raynaud's Phenomenon]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 843: | Line 876: | ||
|- | |- | ||
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Venous insufficiency|Venous disorders]] | ! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Venous insufficiency|Venous disorders]] | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Superior vena cava obstruction]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Superior vena cava obstruction]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 864: | Line 897: | ||
[[Facial]] [[swelling]] | [[Facial]] [[swelling]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Venous stasis]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Venous stasis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 905: | Line 938: | ||
|- | |- | ||
! colspan="2" rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hematologic diseases]] | ! colspan="2" rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hematologic diseases]] | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Methemoglobinemia]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Methemoglobinemia]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 924: | Line 957: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Headache]], [[Altered mental status]], [[Delirium]], [[Seizure]], [[Coma]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Headache]], [[Altered mental status]], [[Delirium]], [[Seizure]], [[Coma]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Polycythemia]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Polycythemia]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 944: | Line 977: | ||
|- | |- | ||
! colspan="2" rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Neurological disease]] | ! colspan="2" rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Neurological disease]] | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Breath-holding spells]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Breath-holding spells]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 963: | Line 996: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fainting]], [[Twitching|Twitching muscles]], [[Seizure]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fainting]], [[Twitching|Twitching muscles]], [[Seizure]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Seizure]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Seizure]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 982: | Line 1,015: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fainting]], [[Tonic-clonic|Tonic-clonic movements]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fainting]], [[Tonic-clonic|Tonic-clonic movements]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Coma]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Coma]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 1,001: | Line 1,034: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Depressed [[brainstem]] reflexes, [[Agonal breathing]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Depressed [[brainstem]] reflexes, [[Agonal breathing]] | ||
|- | |- | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Head trauma]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Head trauma]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 1,021: | Line 1,054: | ||
|- | |- | ||
! colspan="2" rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Miscellaneous | ! colspan="2" rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Miscellaneous | ||
! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[High altitude exposure]] | ! colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[High altitude exposure]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/- | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/- | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 1,040: | Line 1,073: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Dizziness]], [[Coma]], Death | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Dizziness]], [[Coma]], Death | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Septic shock]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Septic shock]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
Line 1,059: | Line 1,092: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Chills]], [[Hypothermia]], [[Loss of consciousness]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Chills]], [[Hypothermia]], [[Loss of consciousness]] | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Smoke inhalation]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Smoke inhalation]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/- | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/- | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
Line 1,078: | Line 1,111: | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cough]], [[Hoarseness]], [[Hemoptysis]], [[Headache]], [[Fainting]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cough]], [[Hoarseness]], [[Hemoptysis]], [[Headache]], [[Fainting]] | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cold exposure]] | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cold exposure]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - |
Revision as of 17:37, 14 April 2020
Congenital cyanotic heart disease Microchapters |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D. Eiman Ghaffarpasand, M.D. [2]
Overview
Congenital cyanotic heart disease is a group of heart defects that will causes neonatal cyanosis. The patient appears blue (cyanotic), due to deoxygenated blood bypassing the lungs and entering the systemic circulation. This can be caused by right-to-left or bidirectional shunting, or malposition of the great arteries. Such defects include persistent truncus arteriosus, total anomalous pulmonary venous connection, tetralogy of Fallot, transposition of the great vessels, and Ebstein's anomaly.
Classification
Congenital cyanotic heart disease may be classified according to anatomical defect into 5 subgroups:
- Tetralogy of fallot
- It is understood that tetralogy of fallot is the result of improper positioning of the outlet septum.
- In the normal heart, the outlet septum is an indistinguishable component of the crista supraventricularis that communicates with the septomarginal trabeculae to divide the right and left ventricular cavities.
- In Tetralogy of Fallot, proper ventricular septation is perturbed by anterocephalad displacement of the outlet septum relative to the septomarginal trabecula.
- The direct consequence of this misalignment is an overriding aortic orifice and a ventricular septal defect, resulting in an intracardiac right to left shunt of blood.
- In addition, anterocephalad displacement of the outlet septum indirectly predisposes the pulmonary trunk to stenosis in the setting of septoparietal trabecular hypertrophy.
- Together, the displacement of the outlet septum coupled with the hypertrophic arrangement of the septoparietal trabeculae account for the three anatomical cardinal defects in Tetralogy of Fallot - aortic dextroposition, interventricular communication (VSD), and pulmonary stenosis.
- The fourth defect - right ventricular hypertrophy - is a hemodynamic consequence of these three morphologic changes, as the right ventricle physiologically adapts to the increased resistance of a stenotic pulmonary trunk.
- Total anomalous pulmonary venous connection
- n this condition,the right side of heart is receiving blood both from pulmonary and systemic circulation.
- There is a mixing of oxygenated pulmonary venous blood with deoxygenated blood from systemic circulation.
- The mixing of blood could occur at three levels i.e. supracardiac, infracardiac and cardiac.
- In the former two the mixing occurs outside the heart and in latter inside the heart (right atrium)
- Transposition of the great arteries
- In the TGA the aorta arises from the morphologic right ventricle via a subaortic infundibulum and the pulmonary artery arises from the morphologic left ventricle, without a subpulmonary infundibulum.[1][2][3][4]
- These ventriculoarterial connection is known as ventriculoarterial discordance.
- As a consequence, there is a a fibrous continuity between the mitral and pulmonary valve, but no continuity between the tricuspid and aortic valve.
- The abnormal origin of the great arteries results in an altered spiral relationship.
- Therefore, the aorta and pulmonary artery run parallel to each other
- In normal heart thus the circulation is in series.
- However, in transposition of the great vessels circulation is in parallel
- Truncus arteriosus
- In truncus arteriosus, the pulmonary arteries are connected to the aorta.
- A decrease in PVR at birth causes a left to right shunt with evidence of congestive heart failure.
- These patients have a very high incidence of pulmonary hypertension and vascular disease.
- Ebstein's anomaly
- Pathophysiology mainly involves the right ventricle, right atrium and tricuspid valve: [5][6][7][8]
- Failure of TV(tricuspid valve) leaflet delamination
- Apical descent of the functional tricuspid orifice
- Right ventricular dilation and “atrialization”
- Anterior leaflet abnormal fenestrations and tethering
- Right atrioventricular junction dilation
- Pathophysiology mainly involves the right ventricle, right atrium and tricuspid valve: [5][6][7][8]
Differential diagnosis
Congenital cyanotic heart disease should be differentiated from other conditions that causes cyanosis:
References
- ↑ Warnes CA (December 2006). "Transposition of the great arteries". Circulation. 114 (24): 2699–709. doi:10.1161/CIRCULATIONAHA.105.592352. PMID 17159076.
- ↑ Levin, Daniel L. (1977). "d-Transposition of the Great Vessels in the Neonate". Archives of Internal Medicine. 137 (10): 1421. doi:10.1001/archinte.1977.03630220061015. ISSN 0003-9926.
- ↑ Rashkind, William J. (1966). "Creation of an Atrial Septal Defect Without Thoracotomy". JAMA. 196 (11): 991. doi:10.1001/jama.1966.03100240125026. ISSN 0098-7484.
- ↑ Hornung TS, Bernard EJ, Celermajer DS, Jaeggi E, Howman-Giles RB, Chard RB, Hawker RE (November 1999). "Right ventricular dysfunction in congenitally corrected transposition of the great arteries". Am. J. Cardiol. 84 (9): 1116–9, A10. doi:10.1016/s0002-9149(99)00516-0. PMID 10569681.
- ↑ Kloesel B, DiNardo JA, Body SC (September 2016). "Cardiac Embryology and Molecular Mechanisms of Congenital Heart Disease: A Primer for Anesthesiologists". Anesth. Analg. 123 (3): 551–69. doi:10.1213/ANE.0000000000001451. PMC 4996372. PMID 27541719.
- ↑ Postma AV, van Engelen K, van de Meerakker J, Rahman T, Probst S, Baars MJ, Bauer U, Pickardt T, Sperling SR, Berger F, Moorman AF, Mulder BJ, Thierfelder L, Keavney B, Goodship J, Klaassen S (February 2011). "Mutations in the sarcomere gene MYH7 in Ebstein anomaly". Circ Cardiovasc Genet. 4 (1): 43–50. doi:10.1161/CIRCGENETICS.110.957985. PMID 21127202.
- ↑ Bettinelli AL, Mulder TJ, Funke BH, Lafferty KA, Longo SA, Niyazov DM (December 2013). "Familial ebstein anomaly, left ventricular hypertrabeculation, and ventricular septal defect associated with a MYH7 mutation". Am. J. Med. Genet. A. 161A (12): 3187–90. doi:10.1002/ajmg.a.36182. PMID 23956225.
- ↑ Holst KA, Connolly HM, Dearani JA (2019). "Ebstein's Anomaly". Methodist Debakey Cardiovasc J. 15 (2): 138–144. doi:10.14797/mdcj-15-2-138. PMC 6668741 Check
|pmc=
value (help). PMID 31384377.