DORV, Epstein Anomaly, and TOF | Baamboozle - Baamboozle

English 10 Public

3 CHD's

Study Slideshow

Tetrology of Fallot has 4 linked problems:

RVOT obstruction (PS/PA), VSD, overriding aorta (over RV), RV hypertrophy https://upload.medbullets.com/topic/120002/images/tof-updated.jpg

Everything we see at the bedside comes from how blood chooses the path of ___ ___ through these structures

least resistance

TOF: what happens if the atrial septum is intact?

No RA -> LA decompression, no back-up mixing route. Qp/Qs becomes dependant on RVOTO & SVR. Sm. changes in preload, afterload, or PVR = desat + cardiac output

TOF: If SVR decreases, it becomes easier for blood to flow...?

into the aorta. Qs improves. More blood is shunted to the right --> left across the VSD. Qp decreases. Oxygenation worsens. Tet spell!

In TOF: blood exiting the RV must choose between (2):

1. Pulmonary circulation (thru narrowed RVOT) or 2. Systemic circulation (across VSD into the overriding aorta)

TOF: If SVR increases (squatting, knees-to-chest, pain-induced vasoconstriction), it becomes more difficult for blood to

enter the aorta, Qs decreases while Qp increases. PBF improves.

What is a tet spell?

an episode of acute, severe right-to-left shunting

How do we resolve a Tet spell?

Increase SVR: knees to chest (inc. SVR), vasoconstrictors (vaso/phenyl), & sedation

TOF: Are they ductal dependent? If so, why?

Depends: Pulm atresia/ severe pulm stenosis=RVOTO, and needs PDA

TOF: Pulmonary blood flow is dependent on?

PDA and or MAPCAS.