Paper 2 Answers
James Wigley, Saran Shantikumar, Andrew Paul Monk in Get Through, 2014
There are several objective signs of airway obstruction. Agitation can result from hypoxia, and hypercarbia can cause obtundation. Cyanosis can be observed in the nail beds and circumoral skin, and indicates hypoxaemia secondary to inadequate ventilation. Accessory muscles are employed in an attempt to improve ventilation in the setting of airway compromise. Other objective features of airway obstruction include noisy breathing (for example, snoring or stridor with partial occlusion of the pharynx/larynx) or dysphonia (hoarseness) with laryngeal obstruction.
Tetralogy of Fallot
Jana Popelová, Erwin Oechslin, Harald Kaemmerer, Martin G St John Sutton, Pavel Žáček in Congenital Heart Disease in Adults, 2008
The tetralogy of Fallot (TOF) defect originates from a deviation of the infundibular septum to the right and anterocephalad, resulting in a hypoplasia of the right ventricular outflow tract and the pulmonary artery system, a subaortic malalignment ventricular septal defect (VSD), and an aortic overriding. About 25% of patients with TOF have a right-side aortic arch, frequently seen in patients with TOF and microdelection on chromosome 22q11. Critical considerations in unoperated TOF are the size of the VSD, shunt direction and amount, the severity of the Right ventricular outflow tract obstruction, and the degree of pulmonary artery hypoplasia. TOF is the most common cyanotic cardiac anomaly in adulthood, present in 4–10% of all congenital heart diseases. At a time when surgery was unavailable, only 11% of TOF patients survived beyond 20 years of age, with only 3% of patients living to 40 years of age.
Children are different from adults
Elizabeth Charnock, Angela Lee, Amanda Miller in Nursing & Health Survival Guide, 2014
Children respond differently to illness than adults, often deteriorating more rapidly. Remember: if any of the following signs are observed, call for emergency help as the child is in a state of imminent collapse. Exhaustion: not to be mistaken for signs of improvement. Rapid reduction in respiratory or heart rates is not necessarily a mark of improvement and may instead indicate exhaustion and pending collapse. Analyse observation trends to ensure accurate interpretation of the child's condition. Bradycardia: a pulse rate less than 60 beats per minute. A rapidly falling heart rate. Gasping: indicative of severe hypoxia, which leads to bradycardia. Cyanosis: a late sign of hypoxia. Hypotension: a late sign of circulatory failure. Absent peripheral and weak central pulses: a sign of advanced shock.
Uncorrected acyanotic tetralogy of Fallot decompensated in adulthood after an acute onset of malaria
Published in Acta Cardiologica, 2012
Jacques Auslender, Liliane Jahjah, Marielle Morissens
Tetralogy of Fallot is the most frequent cyanotic congenital heart disease. Usually, the condition is diagnosed and treated during the fi rst year of life. Few reports of uncorrected tetralogy of Fallot reaching adulthood are found in the literature. Occasionally the pulmonary obstruction is relatively mild and the presentation is with minimal cyanosis. This particular situation is called “pink tetralogy” or “acyanotic tetralogy”. For these adults surgical repair is still recommended, since the results of surgery are good and the operative risk is low. We report the case of a 55-year-old man with an uncorrected acyanotic tetralogy of Fallot diagnosed after right cardiac failure triggered by an acute onset of malaria.
Intermittent cyanosis due to prominent eustachian valve in a newborn infant
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2009
Kazushi Yasuda, Satoru Iwashima, Hiroshi Sugiura, Shigeru Ohki, Masashi Seguchi
A full-term neonate presented with cyanosis only when sleeping, which was considered due to a prominent eustachian valve, directing blood flow from the inferior vena cava to the left atrium through the foramen ovale resulting in interatrial right-to-left shunting. In addition to the anatomical features, hemodynamic features shortly after birth, such as patent foramen ovale and high pulmonary vascular resistance, were also probably involved in the mechanism responsible for the patient's cyanosis. This case may provide insight into differential diagnosis for cyanotic infants.
An unusual form of Naxos disease and its improvement by adjuvant low-dose colchicine therapy
Published in Acta Cardiologica, 2013
Nazmi Gultekin, Emine Kucukates
We evaluated a female patient with an unusual form of Naxos disease, who presented with central cyanosis and clubbing, simulating congenital heart disease. Adjuvant low-dose colchicine therapy (0.5 mg once daily) showed positive eff ects and has been continued for six months. Colchicine has anti-infl ammatory and anti-fi brotic properties. It inhibits mitosis by disrupting tubulin assembly and enhances cellular apoptosis. Follow-up showed improvement in the patient’s clinical status, with a dramatic disappearance of the electrical storm and reductions in cyanosis and palmoplantar hyperkeratosis. Low-dose colchicine may be safe and eff ective in patients with Naxos disease and may reduce related complications.
Related Knowledge Centers
- Anemia
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- Hypoxia
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- Thrombosis
- Signs & Symptoms
- Intracranial Hemorrhage