Dextro-transposition of the great arteries physical examination: Difference between revisions

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Latest revision as of 14:00, 2 November 2012

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Keri Shafer, M.D. [4]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [5]

Overview

Cyanosis and Clubbing can be seen on physical examination. The findings on physical examination are modified depending on the accompanying lesion seen i.e. ventricular septal defect, fossa ovalis, patent ductus areriosus.

Physical Examination

Heart

There is a prominent impulse at the LLSB (the right ventricle which is actually the morphologic left ventricle).
The first heart sound (S1) is normal in intensity and splitting because the PR interval and ventricular activation is normal. Due to the anterior location of the aorta, the second heart sound (S2) is accentuated and is usually single.
The murmur of a large patent ductus arteriosus in d-TGA, is usually systolic, seldom continuos, due to the almost exclusive flow during systole from the aorta to the pulmonary artery.
Systolic murmus are absent in neonates unless a subpulmonic stenosis is present. Short midsystolic murmur originate in the anterior aorta when hypervolemia is present. When the pulmonary vascular resistence is low, a midsystolic murmur is originated in the posterior pulmonary artery, but the murmur is dump by the anterior aorta.
A VSD murmur (holosystolic)is absent at birth, until the pulmonary vascular resistence fall. A subsequent increase in pulmonary resistence shortens and later abolishes the murmur.

Extremities

Symmetric cyanosis
Delayed mild cyanosis, and the apearence of congestive heart failure accompanies non-restrictive VSD.
Reversed differential cyanosis (feet less cyanotic than hands) can be a manifestation in patients with d-TGA and large patent ductus arteriosus that has develop early pulmonary vascular disease, reversing the ductal flow if the patient has survived. At this point in time, the pulmonary arterial blood of high oxygen content enters the aorta and is selectively distribuited to the lower extremities.

References

Template:WH Template:WS

@@ Line 1: / Line 1: @@
-{{Dextro-transposition of the great arteries/complete transposition of the great arteries}}
+__NOTOC__
+{{Dextro-transposition of the great arteries}}
-'''For patient information click [[Transposition of the great vessels(patient information)|here]]'''
+{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{CZ}}; [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; '''Assistant Editor(s)-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu]
-{{CMG}}
+==Overview==
+Cyanosis and Clubbing can be seen on physical examination. The findings on physical examination are modified depending on the accompanying lesion seen i.e. ventricular septal defect, fossa ovalis, patent ductus areriosus.
+==Physical Examination==
+===Heart===
+* There is a prominent impulse at the LLSB (the right ventricle which is actually the morphologic left ventricle).
+* The first heart sound (S1) is normal in intensity and splitting because the PR interval and ventricular activation is normal. Due to the anterior location of the aorta, the second heart sound (S2) is accentuated and is usually single.
+* The murmur of a large patent ductus arteriosus in d-TGA, is usually systolic, seldom continuos, due to the almost exclusive flow during systole from the aorta to the pulmonary artery.
+* Systolic murmus are absent in neonates unless a subpulmonic stenosis is present. Short midsystolic murmur originate in the anterior aorta when hypervolemia is present. When the pulmonary vascular resistence is low, a midsystolic murmur is originated in the posterior pulmonary artery, but the murmur is dump by the anterior aorta.
+* A VSD murmur (holosystolic)is absent at birth, until the pulmonary vascular resistence fall. A subsequent increase in pulmonary resistence shortens and later abolishes the murmur.
-'''Associate Editors-In-Chief:''' [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; Atif Mohammad, M.D., [[Priyamvada Singh]], [[MBBS]]
+===Extremities===
+* Symmetric cyanosis
+* Delayed mild cyanosis, and the apearence of congestive heart failure accompanies non-restrictive VSD.
-==== Physical Examination in Infants with d-TGA ====
+* Reversed differential cyanosis (feet less cyanotic than hands) can be a manifestation in patients with d-TGA and '''large patent ductus arteriosus''' that has develop early pulmonary vascular disease, reversing the ductal flow if the patient has survived. At this point in time, the pulmonary arterial blood of high oxygen content enters the aorta and is selectively distribuited to the lower extremities.
-Symmetric cyanosis is the main characteristic in physical appearence of patients with d-TGA, inadequate mixing, and low pulmonary arterial blood flow. Delayed mild cyanosis, and the apearence of congestive heart failure accompanies non-restrictive VSD.
-Reversed differential cyanosis (feet less cyanotic than hands) can be a manifestation in patients with d-TGA and '''large patent ductus arteriosus''' that has develop early pulmonary vascular disease, reversing the ductal flow if the patient has survived. At this poin in time, the pulmonary arterial blood of high oxygen content enters the aorta and is selectively distribuited to the lower extremities.
-The murmur of a large PDA in d-TGA, is usually systolic, seldom continuos, due to the almost exclusive flow during systole from the aorta to the pulmonary artery.
-There is a prominent impulse at the LLSB (the RV which is actually the morphologic LV).
-The first heart sound (S1) is normal in intensity and splitting because the PR interval and ventricular activation is normal. Due to the anterior location of the aorta, the second heart sound (S2) is accentuated and is usually single.
-Systolic murmus are absent '''in neonates''' unless a subpulmonic stenosis is present. Short midsystolic murmur originate in the anterior aorta when hypervolemia is present. When the '''pulmonary vascular resistence''' is low, a midsystolic murmur is originated in the posterior pulmonary artery, but the murmur is dump by the anterior aorta.
-A '''VSD''' murmur (holosystolic)is absent at birth, until the pulmonary vascular resistence fall. A subsequent increase in pulmonary resistence shortens and later abolishes the murmur.
 ==References==
 {{reflist|2}}
-==Acknowledgements and Initial Contributors to Page==
+{{WH}}
-Leida Perez, M.D.
+{{WS}}
-==External links==
-*[http://www.kumc.edu/instruction/medicine/pedcard/cardiology/pedcardio/dtgadiagram.gif Diagram at kumc.edu]
-*[http://www.med.umich.edu/cvc/mchc/partran.htm Diagram and description at umich.edu]
-*[http://www.pediheart.org/practitioners/defects/ventriculoarterial/l-TGA.htm Overview at pediheart.org]
-*[http://www.rch.org.au/cardiology/defects.cfm?doc_id=5098 Royal Children's Hospital, Melbourne]
-*[http://www.mayoclinic.org/corrected-transposition-great-arteries Mayo Clinic, Arizona - Florida - Minnesota, USA]
-[[fr:Transposition des gros vaisseaux]]
+[[Category:Disease]]
-[[nl:Transpositie van de grote vaten]]
-[[zh:大血管轉位]]
-[[Category:DiseaseState]]
 [[Category:Cardiology]]
 [[Category:Congenital heart disease]]
-{{WH}}
-{{WS}}