1. A concerned couple comes into pediatric clinic with their new adopted baby who noticed that recently when the baby starts to cry, she becomes more fussy. They started to notice this around the baby's 3 month mark. Now, approaching 4 months old, the baby seems to be more irritable, moving more, and has now started to have episodes where her lips, fingers, and toes turn blue.
A chest radiograph shows the following:
a. Based on your clinical suspicion, why do you think the infant has become increasingly fussy when crying? Name the congenital heart defect and the pathophysiology behind the infants reaction.
Tetralogy of Fallot
-Caused by sudden increase in hypoxemia and cyanosis
-Movement increases systemic vascular resistance, causing temporary reversal of the shunt.
b. Using the two images, identify the two congenital heart defects which would increase oxygenation in this infant. Of the two congenital heart defect presented, which can be manipulated at birth through pharmacological intervention?
PDA- through prostaglandins
Congenital Heart Defect 1 -ASD
c. After identifying the four anomalies that make up the Tetralogy of Fallot, name the one whose severity correlates with presence or absence of cyanosis.
-Ventricular Septal Defect
-Infundibular or valvular pulmonary stenosis
-Right ventricular hypertrophy
-Destrorotated aorta with right-sided aortic arch
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