Presentation on tetralogy of fallot
- 1. WELCOME TO MY PRESENTATION
- 2. PARTICULARS OF THE PATIENT : Name : Akbar Hossain Age : 4 Month Sex : Male Religion : Islam Address : sundorpur, Kobirhat, Noakhali Date of Admission : 13.12.18 Date of Examination : 17.12.18
- 3. Chief Complaints: - Respiratory distress for 7 days - Coughing for 10 days - Bluish coloration of the tongue, lips, fingers and toes since two months of age
- 4. H/O PRESENT ILLNESS: According to the statement of the mother, he was reasonably well 2 months back then he developed bluish coloration of lips, tongue, fingers and toes which worsens during feeding, crying and activities. He had history of not growing well and effort intolerance more marked during crying and after feeding. Mother also complaints of cough for 10 days and respiratory distress for 7 days. For these complaints he got admitted into this hospital for better management and evaluation.
- 5. H/O PAST ILLNESS: Not significant. FAMILY HISTORY: All of his family members are in good health. There is no such type of illness in his family. PERSONAL HISTORY: The patient is on exclusive breast feeding SOCIOECONOMIC HISTORY: He belongs to a lower class family. His father works in a factory.
- 6. DRUG HISTORY: Nothing significant IMMUNIZATION HISTORY: He is immunized as per as immunization schedule.
- 7. , GENERAL EXAMINATION: ▪ Appearance: Ill looking , mildly pale ▪ Cyanosis: present (Involving tongue,lips,fingers & toes) ▪ Jaundice: Absent ▪ Clubbing : Present ▪ Edema: Absent ▪ Conjunctiva : Not congested
- 8. ▪ Koilonychia: Absent ▪ Leuconychia: Absent ▪ Dehydration: Absent ▪ Lymphnodes: Not palpable ▪ Pulse: 90 beats/min ▪ Temperature: 98◦F ▪ Respiratory rate: 50/min
- 9. SYSTEMIC EXAMINATION: PRECORDIUM: 1.INSPECTION: • Bulged precordium • No visible apex beat & impulses 2.PALPATION: • Apex beat- palpable in the left 5th intercostal space just medial to left midclavicular line & normal in character.
- 10. • Left parasternal heave- present • A systolic thrill is present in the left upper intercostal space. • No palpable p2 3.AUSCULTATION: • S1 is normal in all areas • S2 is loud • There is ejection systolic murmur best heard over pulmonary area • No added sound
- 11. RESPIRATORY SYSTEM: 1.INSPECTION: • Fast breathing • Chest indrawing present • No suprasternal recession 2.PALPATION: • Position of the trachea: Central 3.PERCUSSION: • Hyper-resonant
- 12. 4.AUSCULTATION: • Breath sound is vesicular with prolong expiration • Widespread ronchi Examinations of other systems reveal normal findings.
- 13. SALIENT FEATURES: Akbar Hossain, 4 months old, male baby, immunized, non- consanguinous parents hailing from Sundorpur, Kabirhat, Noakhali admitted in this hospital with the complaints of bluish coloration of lips, tongue, fingers and toes since 2 months of age which worsens during feeding, crying and activities. He had history of not growing well and effort intolerance more marked during crying. activities and after feeding. Mother also complaints of cough for 10 days and respiratory distress for 7 days. The child is on exclusive breast feed & no history of convulsion & unconsciousness.
- 14. On general examination- patient is ill looking, dyspnoeic, mildly pale, cyanosed involving tongue, lips, fingers and toes. Pulse 90/min, temperature 98◦F, respiratory rate 50 b/min. On precordium examination- bulged precordium, apex beat is palpable in the left 5th intercostal space just medial to the left midclavicular line, left parasternal heave present, no palpable p2, S2 loud, ejection systolic
- 15. murmur best heard over the pulmonary area. On respiratory system examination- there are fast breathing, chest indrawing, no suprasternal recession, hyperresonant on percussion, breath sound is vesicular with prolonged expiration & widespread ronchi. Examinations of other systems reveal no abnormalities.
- 16. PROVISIONAL DIAGNOSIS: A cyanotic heart disease (Most probably Tetralogy of Fallot) with bronchiolitis. DIFFERENCIAL DIAGNOSIS: Severe Pulmonary Stenosis
- 17. INVESTIGATIONS: • CBC: Hb% 10gm/dl, WBC count 8500/cmm, ESR 10mm in 1st hour • Chest X-ray P/A view: Boot shaped heart, pulmonary conus is concave, hypertranslucent lung fields, low lying diaphragm • Echocardiography: Right ventricle is hypertrophied, aorta is dilated & overrides with non-restrictive VSD, pulmonary artery is narrowed
- 18. TREATMENT: 1. Medical Treatment: • O2 inhalation • Nebulization with ipratropium bromide & normal saline. • Propranolol 0.25-1 mg/kg/day orally • Iron supplementation • Vitamins & minerals supplementation • High calorie diet
- 19. 2. Surgical Treatment: • Total correction: Surgical relieve of pulmonary stenosis & VSD • Palliative surgery: Blalock Taussing Shunt